Scaled-based methods and apparatuses for automatically updating patient profiles

ABSTRACT

Aspects of the present disclosure are directed to an apparatus comprising a scale and external circuitry. The scale includes a platform, data-procurement circuitry to engage the user with electrical signals and collect signals indicative of the user&#39;s identity and cardio-physiological measurements while the user is standing on the platform, processing circuitry to process data obtained by the data-procurement circuitry while the user is standing on the platform and therefrom generate cardio-related physiologic data corresponding to the collected signals, and an output circuit. The output circuit sends user data, including data indicative of the user&#39;s identity and the generated cardio-related physiologic data, for reception at external circuitry. The external circuitry receives the user data, validates the cardio-related physiologic data as concerning the user associated with a patient profile, and updates the patient profile using the generated cardio-related physiologic data.

RELATED APPLICATION DATA

This application is related to PCT Application (Ser. No.PCT/US2016/062484), entitled “Scale-Based Parameter Acquisition Methodsand Apparatuses”, filed on Nov. 17, 2016, PCT Application (Ser. No.PCT/US2016/062505), entitled “Remote Physiologic Parameter AssessmentMethods and Platform Apparatuses”, filed on Nov. 17, 2016, U.S.Provisional Application (Ser. No. 62/258,253), entitled “InitializationMethod and Devices and User Physiological Platforms”, filed Nov. 20,2015, filed Nov. 20, 2015, U.S. Provisional Application (Ser. No.62/264,807), entitled “Diagnostic-Capable Scale for Auto-UpdatingPatient Profiles Using Scale Collected User data”, filed Dec. 8, 2015,and U.S. Provisional Application (Ser. No. 62/266,523), entitled “SocialGrouping Using a User-Specific Scale-Based Enterprise System”, filedDec. 11, 2015”, which are fully incorporated herein by reference.

OVERVIEW

Various aspects of the present disclosure are directed toward methods,systems and apparatuses that are useful in automatically updatingpatient profiles using scale collected user data.

Various aspects of the present disclosure are directed to monitoringdifferent physiological characteristics for many different applications.For instance, physiological monitoring instruments are often used tomeasure a number of patient vital signs, including blood oxygen level,body temperature, respiration rate and electrical activity forelectrocardiogram (ECG) or electroencephalogram (EEG) measurements. ForECG measurements, a number of electrocardiograph leads may be connectedto a patient's skin, and are used to obtain a signal from the patient.

Obtaining physiological signals (e.g., data) can often require specialtyequipment and intervention with medical professionals. For manyapplications, such requirements may be costly or burdensome. These andother matters have presented challenges to monitoring physiologicalcharacteristics.

Aspects of the present disclosure are directed to a platform apparatusand external circuitry that provide various features to automaticallyupdate a medical profile of a patient and/or check-in a patient's at aphysician's office, clinic, hospital, and/or other health-relatedfacilities. The platform apparatus, such as a body weight scale,provides the feature of checking-in a patient by collectingscale-obtained data including cardio-physiological measurements from auser while the user is standing on the platform apparatus and outputtingthe scale-obtained data to external circuitry. In various relatedaspects, the platform apparatus asks the user for various symptomsand/or reasons for visiting the physician's office, clinic, hospital,and/or other health-related facilities. The external circuitry uses thescale-obtained data by validating the scale obtained-data ascorresponding to a medical profile and automatically updating themedical profile of the user using the scale-obtained data. In variousaspects, the external circuitry provides additional optional featuressuch as determining clinical indications using the scale-obtained data,providing an indication to staff that the user is checked-in, providingaccess to the staff to the scale-obtained data and/or clinicalindications, and/or providing an alert in response to the scale-obtaineddata being indicative of an emergency and/or particular condition of theuser.

Specific aspects are directed to an apparatus including a scale andexternal circuitry. The scale includes a platform configured andarranged for a user to stand on, data-procurement circuitry, processingcircuitry, and an output circuit. The data-procurement circuitryincludes force sensor circuitry and a plurality of electrodes integratedwith the platform, and is used to engage the user with electricalsignals and collect signals indicative of the user's identity andcardio-physiological measurements while the user is standing on theplatform. The processing circuitry includes a CPU and a memory circuitwith user-corresponding data stored in the memory circuit. Theprocessing circuitry is arranged with (e.g., electrically integratedwith or otherwise in communication) the force sensor circuitry and theplurality of electrodes and configured and arranged to process dataobtained by the data-procurement circuitry while the user is standing onthe platform and therefrom generate cardio-related physiologic datacorresponding to the collected signals. The output circuit receive userdata and, in response, sends the user data, including data indicative ofthe user's identity and the generated cardio-related physiologic data,for reception at external circuitry that is not integrated within thescale. The external circuitry, in response to receiving the user data,validates the cardio-related physiologic data as concerning the userassociated with a patient profile using the data indicative of theuser's identity and automatically update the patient profile to includea cardiogram measurement and the user's weight using the generatedcardio-related physiologic data.

Various aspects of the present disclosure are directed towardmultisensory biometric devices, systems and methods. Aspects of thepresent disclosure include user-interactive platforms, such as scales,large and/or full platform-area or dominating-area displays and relatedweighing devices, systems, and methods. Additionally, the presentdisclosure relates to electronic body scales that use impedance-basedbiometric measurements. Various other aspects of the present disclosureare directed to biometrics measurements such as body composition andcardiovascular information. Impedance measurements can be made throughthe feet to measure fat percentage, muscle mass percentage and bodywater percentage. Additionally, foot impedance-based cardiovascularmeasurements can be made for an ECG and sensing the properties of bloodpulsations in the arteries, also known as impedance plethysmography(IPG), where both techniques can be used to quantify heart rate and/orpulse arrival timings (PAT). Cardiovascular IPG measures the change inimpedance through the corresponding arteries between the sensingelectrode pair segments synchronous to each heartbeat.

In certain embodiments, the present disclosure is directed toapparatuses and methods including a scale and external circuitry. Thescale includes a user display to display data to a user while the useris standing on the scale, a platform for a user to stand on,data-procurement circuitry, processing circuitry, and an output circuit.The data-procurement circuitry includes force sensor circuitry and aplurality of electrodes integrated with the platform and configured forengaging the user with electrical signals and collecting signalsindicative of the user's identity and cardio-physiological measurementswhile the user is standing on the platform. The processing circuitryincludes a CPU and a memory circuit with user-corresponding data storedin the memory circuit. The processing circuitry is electricallyintegrated with the force sensor circuitry and the plurality ofelectrodes and configured to process data obtained by thedata-procurement circuitry while the user is standing on the platformand therefrom generate cardio-related physiologic data corresponding tothe collected signals. The output circuit is configured to receive theuser data and, in response, send the user-data, including dataindicative of the user's identity and the generated cardio-relatedphysiologic data, from the scale for reception at external circuitrythat is not integrated within the scale. The output circuit furtherdisplays the user's weight and data indicative of the user's identityand/or the generated cardio-related physiologic data corresponding tothe collected signals.

The external circuitry receives the user data and updates a specificpatent profile (e.g., a medical record). For example, in response toreceiving the user data, external circuitry validates the cardio-relatedphysiologic data as concerning the user associated with a specificpatient profile using the data indicative of the user's identity.Further, the external circuitry automatically updates the specificpatient profile to include a cardiogram measurement and the user'sweight of the user using the generated cardio-related physiologic data.

A number of embodiments include methods for automatically updatingpatient profiles using user data collected by a scale. For example, themethod includes engaging a user, via a scale, with electrical signalsand, therefrom, collecting signals indicative of the user's identity andcardio-physiological measurements while the user is standing on aplatform of the scale. The scale includes a user display to display datato a user while the user is standing on the scale and the platform for auser to stand on. Further, the scale includes data-procurementcircuitry, processing circuitry, and output circuitry. Thedata-procurement circuitry includes force sensor circuitry and aplurality of electrodes integrated with the platform. The processingcircuitry includes a CPU and a memory circuit with user-correspondingdata stored in the memory circuit. The processing circuitry isconfigured and arranged within the scale and under the platform uponwhich the user stands, and is electrically integrated with the forcesensor circuitry and the plurality of electrodes. The method furtherincludes processing, using the processing circuitry, data obtained bythe data-procurement circuitry while the user is standing on theplatform and therefrom generating cardio-related physiologic datacorresponding to the collected signals and displaying the user's weighton the user display. User data is output, using the output circuit, fromthe scale for reception by external circuitry that is not integratedwithin the scale. The user data includes the data indicative of theuser's identity and the generated cardio-related physiologic data. Themethod further includes validating the cardio-related physiologic dataas concerning the user associated with the specific patient profileusing the data indicative of the user's identity and automaticallyupdating, using the external circuitry, the specific patient profile toinclude a cardiogram measurement and the user's weight using thegenerated cardio-related physiologic data.

In another specific embodiment, a method includes receiving, at externalcircuitry, user data corresponding to a plurality of users from aplurality of scales, the user data including data indicative of theusers' identity and cardio-physiological measurements. Each scaleincludes a user display to display data to a user while the user isstanding on the scale, a platform for a user to stand on,data-procurement circuitry, processing circuitry, and an output circuit.The data-procurement circuitry includes force-sensor circuitry and aplurality of electrodes integrated with the platform configured andarranged for engaging the user with electrical signals and collectingsignals indicative of the user's identity and cardio-physiologicalmeasurements while the user is standing on the platform. The processingcircuitry is arranged with the plurality of electrodes to receive thecollected signals obtained by the data-procurement circuitry and, inresponse, derive and output the user data to the external circuitry thatis not integrated within the scale. The method includes receiving andvalidating respective cardio-related physiologic data as concerningrespective users associated with specific patient profiles using thedata indicative of each user's identity and automatically updating,using the external circuitry, the specific patient profiles to include acardiogram measurement and the user's weight using the generatedcardio-related physiologic data.

In another embodiments, an apparatus comprises a plurality of scales andexternal circuitry. Each scale includes a user display to display datato a user while the user is standing on the scale, a platform for a userto stand on, data-procurement circuitry, and processing circuitry. Thedata-procurement circuitry includes force-sensor circuitry and aplurality of electrodes integrated with the platform configured andarranged for engaging the user with electrical signals and collectingsignals indicative of the user's identity and cardio-physiologicalmeasurements while the user is standing on the platform. The processingcircuitry is arranged with the plurality of electrodes to receive thecollected signals obtained by the data-procurement circuitry and, inresponse, derive and output the user-data to the external circuitry forassessment at a remote location that is not integrated within the scale.The external circuitry receives the user-data corresponding to aplurality of users from the plurality of scales, the user-data includingcardio-physiological measurements and data indicative of theuser-identity. Further, the external circuitry validates the respectivecardio-related physiologic data as concerning respective usersassociated with specific patient profiles using the collected signalsindicative of each user's identity and automatically updates thespecific patient profiles to include a cardiogram measurement and theuser's weight using the generated cardio-related physiologic data.

In certain embodiments, aspects of the present disclosure areimplemented in accordance with and/or in combination with aspects of thePCT Application (Ser. No. PCT/US2016/062484), entitled “Scale-BasedParameter Acquisition Methods and Apparatuses”, filed on Nov. 17, 2016,PCT Application (Ser. No. PCT/US2016/062505), entitled “RemotePhysiologic Parameter Assessment Methods and Platform Apparatuses”,filed on Nov. 17, 2016, U.S. Provisional Application (Ser. No.62/258,253), entitled “Initialization Method and Devices and UserPhysiological Platforms”, filed Nov. 20, 2015, U.S. ProvisionalApplication (Ser. No. 62/264,807), entitled “Diagnostic-Capable Scalefor Auto-Updating Patient Profiles Using Scale Collected User data”,filed Dec. 8, 2015, and U.S. Provisional Application (Ser. No.62/266,523), entitled “Social Grouping Using a User-Specific Scale-BasedEnterprise System”, filed Dec. 11, 2015”, which are fully incorporatedherein by reference.

The above discussion/summary is not intended to describe each embodimentor every implementation of the present disclosure. The figures anddetailed description that follow also exemplify various embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

Various example embodiments may be more completely understood inconsideration of the following detailed description in connection withthe accompanying drawings, in which:

FIG. 1a shows an apparatus consistent with aspects of the presentdisclosure;

FIG. 1b shows an example of automatically updating a patient profileusing an apparatus, consistent with aspects of the present disclosure;

FIG. 1c shows an example of a scale wireless communicating with externalcircuitry, consistent with aspects of the present disclosure;

FIG. 1d shows an example of apparatus comprised of a plurality of scaleand external circuitry, consistent with aspects of the presentdisclosure;

FIG. 1e shows current paths through the body for the IPG trigger pulseand Foot IPG, consistent with various aspects of the present disclosure;

FIG. 1f is a flow chart illustrating an example manner in which auser-specific physiologic meter/scale may be programmed to providefeatures consistent with aspects of the present disclosure;

FIG. 2a shows an example of the insensitivity to foot placement on scaleelectrodes with multiple excitation and sensing current paths,consistent with various aspects of the present disclosure;

FIGS. 2b-2c show examples of electrode configurations, consistent withvarious aspects of the disclosure;

FIGS. 3a-3b show example block diagrams depicting circuitry for sensingand measuring the cardiovascular time-varying IPG raw signals and stepsto obtain a filtered IPG waveform, consistent with various aspects ofthe present disclosure;

FIG. 3c depicts an example block diagram of circuitry for operating corecircuits and modules, including for example those of FIGS. 3a -3 b, usedin various specific embodiments of the present disclosure;

FIG. 3d shows an exemplary block diagram depicting the circuitry forinterpreting signals received from electrodes.

FIG. 4 shows an example block diagram depicting signal processing stepsto obtain fiducial references from the individual Leg IPG “beats,” whichare subsequently used to obtain fiducials in the Foot IPG, consistentwith various aspects of the present disclosure;

FIG. 5 shows an example flowchart depicting signal processing to segmentindividual Foot IPG “beats” to produce an averaged IPG waveform ofimproved SNR, which is subsequently used to determine the fiducial ofthe averaged Foot IPG, consistent with various aspects of the presentdisclosure;

FIG. 6a shows examples of the Leg IPG signal with fiducials; thesegmented Leg IPG into beats; and the ensemble-averaged Leg IPG beatwith fiducials and calculated SNR, for an exemplary high-qualityrecording, consistent with various aspects of the present disclosure;

FIG. 6b shows examples of the Foot IPG signal with fiducials derivedfrom the Leg IPG fiducials; the segmented Foot IPG into beats; and theensemble-averaged Foot IPG beat with fiducials and calculated SNR, foran exemplary high-quality recording, consistent with various aspects ofthe present disclosure;

FIG. 7a shows examples of the Leg IPG signal with fiducials; thesegmented Leg IPG into beats; and the ensemble averaged Leg IPG beatwith fiducials and calculated SNR, for an exemplary low-qualityrecording, consistent with various aspects of the present disclosure;

FIG. 7b shows examples of the Foot IPG signal with fiducials derivedfrom the Leg IPG fiducials; the segmented Foot IPG into beats; and theensemble-averaged Foot IPG beat with fiducials and calculated SNR, foran exemplary low-quality recording, consistent with various aspects ofthe present disclosure;

FIG. 8 shows an example correlation plot for the reliability inobtaining the low SNR Foot IPG pulse for a 30-second recording, usingthe first impedance signal as the trigger pulse, from a study including61 test subjects with various heart rates, consistent with variousaspects of the present disclosure;

FIGS. 9a-b show an example configuration to obtain the pulse transittime (PTT), using the first IPG as the triggering pulse for the Foot IPGand ballistocardiogram (BCG), consistent with various aspects of thepresent disclosure;

FIG. 10 shows nomenclature and relationships of various cardiovasculartimings, consistent with various aspects of the present disclosure;

FIG. 11 shows an example graph of PTT correlations for two detectionmethods (white dots) Foot IPG only, and (black dots) Dual-IPG method,consistent with various aspects of the present disclosure;

FIG. 12 shows an example graph of pulse wave velocity (PWV) obtainedfrom the present disclosure compared to the ages of 61 human testsubjects, consistent with various aspects of the present disclosure;

FIG. 13 shows another example of a scale with interleaved footelectrodes to inject and sense current from one foot to another foot,and within one foot, consistent with various aspects of the presentdisclosure;

FIG. 14a shows another example of a scale with interleaved footelectrodes to inject and sense current from one foot to another foot,and measure Foot IPG signals in both feet, consistent with variousaspects of the present disclosure;

FIG. 14b shows another example of a scale with interleaved footelectrodes to inject and sense current from one foot to another foot,and measure Foot IPG signals in both feet, consistent with variousaspects of the present disclosure;

FIG. 14c shows another example approach to floating current sources isthe use of transformer-coupled current sources, consistent with variousaspects of the present disclosure;

FIGS. 15a-d show an example breakdown of a scale with interleaved footelectrodes to inject and sense current from one foot to another foot,and within one foot, consistent with various aspects of the presentdisclosure;

FIG. 16 shows an example block diagram of circuit-based building blocks,consistent with various aspects of the present disclosure;

FIG. 17 shows an example flow diagram, consistent with various aspectsof the present disclosure;

FIG. 18 shows an example scale communicatively coupled to a wirelessdevice, consistent with various aspects of the present disclosure; and

FIGS. 19a-c show example impedance as measured through different partsof the foot based on the foot position, consistent with various aspectsof the present disclosure.

While various embodiments discussed herein are amenable to modificationsand alternative forms, aspects thereof have been shown by way of examplein the drawings and will be described in detail. It should beunderstood, however, that the intention is not to limit the disclosureto the particular embodiments described. On the contrary, the intentionis to cover all modifications, equivalents, and alternatives fallingwithin the scope of the disclosure including aspects defined in theclaims. In addition, the term “example” as used throughout thisapplication is only by way of illustration, and not limitation.

DESCRIPTION

Aspects of the present disclosure are believed to be applicable to avariety of different types of apparatuses, systems, and methodsinvolving automatically updating patient profiles using scale collecteduser data. In certain implementations, aspects of the present disclosurehave been shown to be beneficial when used in the context of a weighingscale with electrodes configured for engaging with the user andgenerating cardio-related physiologic data, such as data indicative of acardiogram of a user. In some embodiments, the scale measures therelevant data while the user is standing on the scale and sends the datato external circuitry. The external circuitry validates the data asconcerning a user associated with a specific patient profile andautomatically updates the specific patient profile with the scalecollected data. Further, the external circuitry, using the scalecollected data, determines clinical indications and provides alerts inresponse to the clinical indication indicating an emergency, such as anindication the user is having a heart attack while waiting to be checkedin to a hospital. These and other aspects can be implemented to addresschallenged, including those discussed in the background above. While notnecessarily so limited, various aspects may be appreciated through adiscussion of examples using such exemplary contexts.

Accordingly, in the following description various specific details areset forth to describe specific examples presented herein. It should beapparent to one skilled in the art, however, that one or more otherexamples and/or variations of these examples may be practiced withoutall the specific details given below. In other instances, well knownfeatures have not been described in detail so as not to obscure thedescription of the examples herein. For ease of illustration, the samereference numerals may be used in different diagrams to refer to thesame elements or additional instances of the same element. Also,although aspects and features may in some cases be described inindividual figures, it will be appreciated that features from one figureor embodiment can be combined with features of another figure orembodiment even though the combination is not explicitly shown orexplicitly described as a combination.

Embodiments of the present disclosure are directed to a platformapparatus and external circuitry that provide various features tocheck-in a patient's at a physician's office, clinic, hospital, and/orother health-related facilities. In some embodiments, the platformapparatus is not located at the health-related facility but in aconsumer setting (e.g., dwelling or nursing home) and is used topre-check in the patient and/or suggest a visit to the physician, asdescribed herein. The platform apparatus, such as a body weight scale,provides the feature of checking-in a patient by collectingscale-obtained data including cardio-physiological measurements from auser while the user is standing on the platform apparatus and outputtingthe scale-obtained data to external circuitry. In various relatedaspects, the platform apparatus asks the user for various symptomsand/or reasons for visiting the physician's office, clinic, hospital,and/or other health-related facilities. The external circuitry uses thescale-obtained data by validating the scale obtained-data ascorresponding to a medical profile and automatically updating themedical profile of the user using the scale-obtained data. In variousaspects, the external circuitry provides additional optional featuressuch as determining clinical indications using the scale-obtained data,providing an indication to staff that the user is checked-in, providingaccess to the staff to the scale-obtained data and/or clinicalindications, and/or providing an alert in response to the scale-obtaineddata being indicative of an emergency and/or particular condition of theuser.

With changes to the healthcare system and increasing governmentregulation on data documentation for patients, data entry for medicalrecords of patients of physicians and hospitals is increasingly. Dataentry can be time consuming, use both human and computer resources, andcan result in lower patient care as the physicians/nurses becomefrustrated and impatient with the changing systems and requirements. Inaccordance with a number of embodiments, physiological parameter data iscollected using an apparatus, such as a weighing scale or other platformthat the user stands on while at checking in and/or waiting atphysician's office, hospital, urgent care, emergency room, nursing home,physical therapist, and/or other relevant venue. The scale, in variousembodiments, is used to check the user in and/or automatically update apatient profile associated with the user without a nurse, physicianand/or other personal manually entering the data. The present disclosureis directed to a substantially-enclosed apparatus, as would be aweighing scale, wherein the apparatus includes a platform which is partof a housing or enclosure and a user-display to output user-specificinformation for the user while the user is standing on the platform. Theplatform includes a surface area with electrodes that are integrated andconfigured and arranged for engaging a user as he or she steps onto theplatform. Within the housing is processing circuitry that includes a CPU(e.g., one or more computer processor circuits) and a memory circuitwith user-corresponding data stored in the memory circuit. The platform,over which the electrodes are integrated, is integrated andcommunicatively connected with the processing circuitry. The processingcircuitry is programmed with modules as a set of integrated circuitrywhich is configured and arranged for automatically obtaining a pluralityof measurement signals (e.g., signals indicative of cardio-physiologicalmeasurements) from the plurality of electrodes. The processing circuitrygenerates, from the signals, cardio-related physiologic data manifestedas user data.

The user data, in various embodiments, is processed to determinephysiologic parameters of the user and other data, such ascardio-physiological data and wellness data. The scale and/or theexternal circuitry confirms identification of the user and validates theuser data as corresponding to the identified user and a patient profileassociated with the identified user. The validation, in a number ofembodiments, is based on user identification data collected from theuser, such as a password, biometric data, voice recognition, facialrecognition, etc. Upon validating the user data, the patient profile isautomatically updated using the user data. For example, the weight ofthe user and a cardiogram of the user is stored in the patient profilewithout a human manually entering the data. The automatic update resultsin reduced use of human resources by the physician, hospital, or othervenue to generate medical documentation, such as documentation that isrequired by government regulations and/or venue policy.

The scale can be used to perform a question and answer session todetermine why the user is visiting and/or symptoms that the user isexperiencing. The results of the question and answer session can beautomatically populated in the patient profile and provided to aphysician or nurse for review. In accordance with various embodiments,the user data and/or question and answer session data is used by theexternal circuitry to determine one or more clinical indications, suchas potential disorders, diseases, and/or risk factors, and provided to aphysician for review. The user, while waiting for the physician and/orfor their own information, is optionally provided with additional healthinformation that correlates to the user data, information from thequestion and answer session, and/or the clinical indications. Forexample, the external circuitry may determine the user is at risk forheart disease and the external circuitry can output general heartdisease symptoms, risks, and/or advice to the user (e.g., email, send toan application on a smart phone, or print on a printer at the venue forthe user). In other embodiments, based on the answers session data, thescale can suggest that the user visit a physician and, in response touser input indicating an interest in visiting the physician, output thedata to the external circuitry as part of a check-in process (e.g.,pre-check in prior to the user being at the health facility).

In various embodiments, the scale is used to check the user in. Forexample, in response to the update to the patient profile of the user,the external circuitry outputs a signal to circuitry associated with thephysician or other staff. The signal provides an indication that thepatient has been checked-in and is ready to be seen by the physician orother medical personal. The signal may also include an indication thatthe user has a clinical indication for the physician to review. Forinstance, the physician may review the user data and/or the clinicalindication prior to seeing the patient, and discuss the results duringthe same appointment.

As a specific example, a patient may be waiting for a room, such as at ahospital, and may be unaware of the severity of their health situation.The patient may be unaware that they are having a heart attack and didnot provide enough information upon checking in at the hospital for thestaff to identify the problem. Embodiments in accordance with thepresent disclosure include taking vital measurements while a potentialpatient is waiting to be admitted. For example, the cardio-relatedmeasurements, in some embodiments, include or are indicative of pulsewave velocity (PWV) and PWV is correlated to heart failure. While apatient is waiting to be admitted, staff may direct the patient to standon a scale in the waiting room. The scale measures various user data,performs a question and answer session, and outputs various data toexternal circuitry. The external circuitry updates a specific patientprofile using the user data, which may have been generated upon thepatient checking in, and identifies that the user is having and/or is atrisk for heart failure. In response to the identification, the externalcircuitry outputs a signal to provide an indication of the emergencysituation to the nurse station and/or directly to the physician.Thereby, the scale is used to identify the emergency situation andprovide a quicker response by the venue.

The external circuitry can receive user data from a plurality of scales.Each scale provides data for one or more different users and/or can belocated at different locations (e.g., different physicians, differentrooms at an office, or different locations). The scales may be locatedat the respective user's dwellings, commercial settings (e.g., healthcenter, fitness facility), and/or health centers. The external circuitryidentifies the users corresponding to the received user data, validatesthe user data as concerning the identified users associated withspecific patient profiles, and automatically updates the specificpatient profiles with the user data. The external circuitry (and/or thescale) provides clinical indications, such as diagnosis, conditions,and/or treatments, PWV, cardiac output, pre-ejection period and strokevolume by processing the user data from the scales. The externalcircuitry and the scales can be used to update a plurality of differentpatient profiles and reduces data entry by physicians and nursing staff.Such a system can be used in a hospital, in a large doctor's office, fordoctors that have multiple locations, nursing homes, etc.

In other embodiments, a physician and/or other health professional canreview the scale data for patients as a service during a visit atphysician and/or remotely. The scale can be located at the dwelling ofthe user (e.g., home, nursing home, assisted care center) and/or acommercial settings. The scale, responsive to user data being indicativeof a health condition, can offer a service for the physician to reviewthe data and/or for the patient to visit the health professional. Inresponse to user input that activates the service (e.g., indicate aninterest and, optionally, provide a weighted value to activate theservice), the scale outputs the user data to external circuitry that isaccessible by the health professional. If the user already is a clientof the physician, the external circuitry identifies the user and storesthe user data in a patient profile. If the user is a new client, theexternal circuitry generates a new patient profile for the user with theinformation provided.

In accordance with various embodiments, the user-data is based onsensing, detection, and quantification of at least two simultaneouslyacquired impedance-based signals. The simultaneously acquiredimpedance-based signals are associated with quasi-periodicelectro-mechanical cardiovascular functions, and simultaneouscardiovascular signals measured by the impedance sensors, due to thebeating of an individual's heart, where the measured signals are used todetermine at least one cardiovascular related characteristic of the userfor determining the heart activity, health, or abnormality associatedwith the user's cardiovascular system. The sensors can be embedded in auser platform, such as a weighing scale-based platform, where the userstands stationary on the platform, with the user's feet in contact withthe platform, where the impedance measurements are obtained where theuser is standing with bare feet.

In certain embodiments, the plurality of impedance-measurement signalsincludes at least two impedance-measurement signals between the one footand the other location. Further, in certain embodiments, a signal isobtained, based on the timing reference, which is indicative ofsynchronous information and that corresponds to information in a BCG.Additionally, the methods can include conveying modulated currentbetween selected ones of the electrodes. The plurality ofimpedance-measurement signals may, for example, be carried out inresponse to current conveyed between selected ones of the electrodes.Additionally, the methods, consistent with various aspects of thepresent disclosure, include a step of providing an IPG measurementwithin the one foot. Additionally, in certain embodiments, the twoelectrodes contacting one foot of the user are configured in aninter-digitated pattern of positions over a base unit that containscircuitry communicatively coupled to the inter-digitated pattern. Thecircuitry uses the inter-digitated pattern of positions for the step ofdetermining a plurality of pulse characteristic signals based on theplurality of impedance-measurement signals, and for providing an IPGmeasurement within the one foot. As discussed further herein, andfurther described in U.S. patent application Ser. No. 14/338,266 filedon Oct. 7, 2015, which is herein fully incorporated by reference for itsspecific teaching of inter-digitated pattern and general teaching ofsensor circuitry, the circuitry can obtain the physiological data in anumber of manners.

In medical (and security) applications, for example, the impedancemeasurements obtained from the plurality of integrated electrodes canthen be used to provide various cardio-related information that isuser-specific including, as non-limiting examples, synchronousinformation obtained from the user and that corresponds to informationin a cardiogram, a ballistocardiogram (BCG) and an impedanceplethysmography (IPG) measurements. By ensuring that the user, for whomsuch data was obtained, matches other bio-metric data as obtainedconcurrently for the same user, medical (and security) personnel canthen assess, diagnose and/or identify with high degrees of confidenceand accuracy.

The scale and external circuitry can provide various additional healthinformation to the user in response various user inputs and/or the userdata. The additional health information, in various embodiments,includes tables, information, and/or correlates to the cardio-relatedinformation that is determined using the external circuitry and/or thescale (e.g., physiological parameters). In various embodiments, thecardio-related information may indicate the user has and/or is at riskfor a disorder, disease, and/or has a particular symptom. The additionalhealth information is provided to the user that includes genericinformation for the disorder, disease, and/or particular symptom with orwithout specific information about the user and/or an indication thatthe user has and/or is at risk for the disorder, disease, and/orsymptom. In a number of embodiments, the generic information is based onand/or correlated to specific user inputs, such as a category ofinterest (e.g., demographic of interest, disorder/disease of interest),among other inputs. For example, while, after and/or before taking thevarious impedance measurements, the user is asked a number of questions.The scale can display the questions, ask the questions using a naturallanguage interface (e.g., a speaker component of the device asks theuser questions using computer generated sounds). In some embodiments,the scale instructs another user circuitry, such as a user device (e.g.,cell phone, tablet, computing device, smart watch) to ask the questions,and in response to the user's input, the user device provides theresponses to the scale and/or the external circuitry. Based on theinputs, categories of interest for the user are determined and used togenerate the additional health information.

As used herein, a user device includes processing circuitry and outputcircuitry to collect various data (e.g., signals) and communicate thedata to the scale and/or other circuitry. Example user devices includecellphones, tablets, standalone server or CPU, among other devices. Theuser device can be a wearable device that is worn by a user, such as ona user's wrist, head, or chest. Example wearable devices includesmartwatches and fitness bands, smart glasses, chest heart monitors,etc. In other aspects, the user device further includes sensor circuitryor other circuit to collect physiologic data from the user, and, canoptionally be in secured communication with the scale or othercircuitry. For example, the user device includes smartwatches or fitnessbands that collect heart rate and/or ECG and/or body temperature,medical devices, implanted medical devices, smart beds, among otherdevices. Example physiologic data collected by user devices includesglucose measurements, blood pressure, ECG or other cardio-related data,body temperature, among other data. The terms “user device” and“wearable device”, can be interchangeably used.

The external circuitry can controls access to the patient profiles byallowing access to physiological parameters/clinical data and other datato a physician and not allowing access to the physiologicalparameters/clinical indications to the users. For example, somephysicians and/or venues may grant access to the user's to view portionsof their patient profile online and/or externally from the office. Invarious embodiments, the external circuitry allows access to portions ofthe patient profile. For example, the external circuitry generates andoutputs the additional health information for the user to review. Theadditional health information is stored in the patient profile and/orsent to the scale or another user device for display.

In various specific embodiments, the user stands on the scale at aphysician's office while in the room with a nurse. The scale collectssignals using the data-procurement circuitry, and sends at least aportions of the signals to the external circuitry. The externalcircuitry processes the collected signals, sent as user data, validatesthe user data as concerning a user associated with a specific patientprofile, and automatically updates the specific patient profile usingthe user data. During the processing by the external circuitry, thescale (and/or a user device) asks the user a number of questions todetermine why the user is visiting the physician, if the user isexperiencing symptoms, and the user if the user is interested inreceiving various health information (e.g., a table provided that isbased on various demographics, disorders, and/or other categories ofinterest). In response to the user providing various input data, thescale outputs the data to the external circuitry for updating thespecific patient profile. The external circuitry, using the user dataand/or the input data, determines if the user has a clinical indicationand outputs a signal to the physician or a nurse station indicating thatthe patient is checked-in. In some embodiments, the external circuitryderives additional health information using the inputs and the userdata. For example, the external circuitry can determine healthinformation that is based on the demographics the user provides (e.g.,particular sex, age, ethnicity) and various values and/or symptoms of adisorder/disease/symptom correlated to the cardio-related information ofthe user. As a particular specific example, the user can provide thatthey are interested in a table for males, 45-55, and African-American.The user data may indicate that the user has and/or is at risk foratrial fibrillation. In various embodiments, the external circuitrygenerate a table which includes general risk factors and/or symptoms forvarious heart-related conditions, which includes atrial fibrillation,for African-American males ages 45-55. The information provided does notinclude particular values for the user and/or any indication that theuser has atrial fibrillation.

In this manner, the scale is used to automatically update the patientprofile (e.g., a medical record of the patient), provide the patientwith various health information, and provide indications to thephysician of potential clinical indications of the user. The physicianmay review the data and discuss various treatments, suggestions, and/orother information with the patient. Such embodiments reduce humanresources for data entry for medical records as compared to manuallyentering the data and reduce the time it may take a physician to analyzeand/or diagnose the user as the physician has additional informationprior to and/or at the beginning of an appointment.

Turning now to the figures, FIG. 1a shows an apparatus consistent withaspects of the present disclosure. The apparatus includes a platform 101and a user display 102. The user, as illustrated by FIG. 1a is standingon the platform 101 of the apparatus. The user display 102 is arrangedwith the platform 101. As illustrated by the dashed-lines of FIG. 1a ,the apparatus further includes processing circuitry 104,data-procurement circuitry 138, and physiologic sensors 108. That is,the dashed-lines illustrate a closer view of components of theapparatus.

The physiologic sensors 108, in various embodiments, include a pluralityof electrodes integrated with the platform 101. The electrodes andcorresponding force-sensor circuitry 139 are configured to engage theuser with electrical signals and to collect signals indicative of theuser's identity and cardio-physiological measurements while the user isstanding on the platform 101. For example, the signals are indicative ofphysiological parameters of the user and/or are indicative of or includephysiologic data, such as data indicative of a BCG or ECG and/or actualbody weight or heart rate data, among other data. Although theembodiment of FIG. 1a illustrates the force sensor circuitry 109 asseparate from the physiological sensors 108, one of skill in the art mayappreciate that the force sensor circuitry 109 are physiologicalsensors. The user display 102 is arranged with the platform 101 and theelectrodes to output user-specific information for the user while theuser is standing on the platform 101. The processing circuitry 104includes CPU and a memory circuit with user-corresponding data 103stored in the memory circuit. The processing circuitry 104 is arrangedunder the platform 101 upon which the user stands, and is electricallyintegrated with the force-sensor circuitry 139 and the plurality ofelectrodes (e.g., the physiologic sensors 108). The data indicative ofthe identity of the user includes, in various embodiments,user-corresponding data, biometric data obtained using the electrodesand/or force sensor circuitry, voice recognition data, images of theuser, input from a user's device, and/or a combination thereof, and asdiscussed in further detail herein.

The user-corresponding data includes information about the user that mayor may not be obtained using the physiologic sensors 108, such asdemographic information or historical information. Exampleuser-corresponding data includes height, gender, age, ethnicity,exercise habits, eating habits, cholesterol levels, previous healthconditions or treatments, family medical history, and/or a historicalrecord of variations in one or more of the listed data. Theuser-corresponding data is obtained directly from the user (e.g., theuser inputs to the scale) and/or from another circuit (e.g., a smartdevice, such a cellular telephone, smart watch and/or fitness device,cloud system, etc.). For example, the user-corresponding data isobtained and/or stored in a patient profile (e.g., patient profiledatabase 123).

In various embodiments, the processing circuitry 104 is electricallyintegrated with the force-sensor circuitry 139 and the plurality ofelectrodes and configured to process data obtained by thedata-procurement circuitry 138 while the user is standing on theplatform 101. The processing circuitry 104, for example, generatescardio-related physiologic data (e.g., stored in a database, such asphysiological user-data database 107) corresponding to the collectedsignals and that is manifested as user data. Further, the processingcircuitry 104 generates data indicative of the identity of the user,such as a user ID and/or other user identification metadata. The user IDcan be, for example, in response to confirming identification of theuser using the collected signals indicative of the user's identity.

The user data, in some embodiments, includes the raw signals,bodyweight, body mass index, heart rate, body-fat percentage,cardiovascular age, among other data. In various embodiments, theprocessing circuitry 104, with the user display 102, displays at least aportion of the user data to the user. For example, user data that isnot-regulated is displayed to the user, such as user weight.Alternatively and/or in addition, the user data is stored. For example,the user data is stored on the memory circuit of the processingcircuitry 104 (e.g., such as the physiological user-data database 107illustrated by FIG. 1a ). The processing circuitry 104, in variousembodiments, correlates the collected user data (e.g., physiologicuser-data) with user-corresponding data, such as storing identificationmetadata that identifies the user with the respective data. An algorithmto determine the physiologic data from raw signals can be located on thescale, on another device (e.g., external circuitry, cellphone), and on aCloud system. For example, the Cloud system can learn to optimize thedetermination and program the scale to subsequently perform thedetermination locally. The Cloud system can perform the optimization andprogramming for each user of the scale.

In some embodiments, the scale collects physiologic data from otherdevices, such as medical devices, user devices, wearable devices, and/orremote-physiological devices. The data can include glucose measurements,blood pressure, ECG or other cardio-related data, body temperature,among other physiologic data. Further, the scale can act as a hub tocollect data from a variety of sources. The sources includes theabove-noted user devices. The scale can incorporate a web server (URL)that allows secure, remote access to the collected data. For example,the secure access can be used to provide further analysis and/orservices to the user.

The processing circuitry 104 and/or the scale can include an outputcircuit 106. The output circuit 106 receives the user data and, inresponse, sends the user data, including the data indicative of theuser's identity and the generated cardio-related physiologic data, fromthe scale for reception at external circuitry 111 that is not integratedwithin the scale. In various embodiments, the output circuit 106provides data to user via a user interface. The user interface can beintegrated with the platform 101 (e.g., internal to the scale) and/orcan be integrated with external circuitry that is not located under theplatform 101. In some embodiments, the user interface is a plurality ofuser interfaces, in which at least one user interface is integrated withthe platform 101 and at least one user interface is not integrated withthe platform 101.

A user interface includes or refers to interactive components of adevice (e.g., the scale) and circuitry configured to allow interactionof a user with the scale (e.g., hardware input/output components, suchas a screen, speaker components, keyboard, touchscreen, etc., andcircuitry to process the inputs). A user display includes an outputsurface (e.g., screen) that shows text and/or graphical images as anoutput from a device to a user (e.g., cathode ray tube, liquid crystaldisplay, light-emitting diode, organic light-emitting diode, gas plasma,touch screens, etc.) For example, output circuit can provide data fordisplay on the user display 102, such as the user's weight and the dataindicative of the user's identity and/or the generated cardio-relatedphysiologic data corresponding the collected signals. The communication,in various embodiments, includes a wireless communication and/orutilizes a cloud system.

The user interface, as previous described, is or includes a graphicaluser interface (GUI), a foot-controlled user interface (FUI), and/orvoice input/output circuitry. The user interface can be integrated withthe platform 101 (e.g., internal to the scale) and/or can be integratedwith external circuitry that is not located under the platform 101. Insome embodiments, the user interface is a plurality of user interfaces,in which at least one user interface is integrated with the platform 101and at least one user interface is not integrated with the platform 101.Example user interfaces include input/output devices, such as displayscreens, touch screens, microphones, etc.

A FUI is a user interface that allows for the user to interact with thescale via inputs using their foot and/or via graphic icons or visualindicators near the user's foot while standing on the platform. Inspecific aspects, the FUI receives inputs from the user's foot (e.g.,via the platform) to allow the user to interact with the scale. The userinteraction includes the user moving their foot relative to the FUI, theuser contacting a specific portion of the user display, etc. A GUI is auser interface that allows the user to interact with the scale throughgraphical icons and visual indicators. As an example, the externalcircuitry includes a GUI, processing circuitry, and output circuitry tocommunicate with the processing circuitry of the scale. Thecommunication can include a wireless or wired communication. Exampleexternal circuitry can include a wired or wireless tablet, a cellphone(e.g., with an application), a smartwatch or fitness band, smartglasses, a laptop computer, among other devices. In other examples, thescale includes a GUI and voice input/output circuitry (as furtherdescribed below) integrated in the platform 101. The user interact withthe scale via graphical icons and visual indicators provided via the GUIand voice commands from the user to the scale.

Voice input/output circuitry (also sometimes referred to as speechinput/output) can include a speaker, a microphone, processing circuitry,and other optional circuitry. The speaker outputs computer-generatedspeech (e.g., synthetic speech, instructions, and messages) and/or othersounds (e.g., alerts, noise, recordings, etc.) The computer-generatedspeech can be predetermined, such as recorded messages, and/or can bebased on a text-to-speech synthesis that generates speech from computerdata. The microphone captures audio, such a voice commands from the userand produces a computer-readable signal from the audio. For example, thevoice input/output circuitry can include an analog-to-digital converter(ADC) that translates the analog waves captured by the microphone (fromvoice sounds) to digital data. The digital data can be filtered usingfilter circuitry to remove unwanted noise and/or normalize the capturedaudio. The processing circuitry (which can include or be a component ofthe processing circuitry 104) translates the digital data to computercommands using various speech recognition techniques (e.g., patternmatching, pattern and feature matching, language modeling andstatistical analysis, and artificial neural networks, among othertechniques).

The external circuitry 111 receives the user data, and in response,validates the user data as concerning the user associated with aspecific patient profile using the data indicative of the user'sidentity. The validation, in some embodiments, includes comparing userdata to the patient profile. In various embodiments, the data indicativeof the user's identity is the user ID and/or is associated with the userID (e.g., is mapped to and/or otherwise correlated to). In a number ofembodiments, the external circuitry 111 includes and/or is incommunication with a patient profile database 123. The patient profiledatabase 123 stores a plurality of patient profiles, each correspondingto a specific user. Each patient profile includes medical data,demographic data, historical user data, and user identification data,among other information. For example, the patient profiles can bemedical records. The data in the patient profiles is searched by theexternal circuitry 111 and matched to the data indicative of the user'sidentity within the user data.

In specific embodiments, the validation includes comparing a physiologicparameter and/or other biometric data determined using the user data todata within the patient profile. For example, the biometric data iscaptured by the data-procurement circuitry 138 and can include thelength of the foot, the width of the foot, foot shape, toe print, facialrecognition, etc. The physiologic parameter can include a BCGmeasurement determined using the user data. In various embodiments, thescale determines the physiological parameter and outputs thephysiological parameter as user data. Alternatively, the externalcircuitry 111 determines the physiological parameter.

Biometrics, as used herein, are metrics related to human characteristicsand used as a form of identification and access control. Scale-basedbiometrics includes biometrics that are obtained using signals collectedby the data-procurement circuitry of the scale (e.g., using electrodesand/or force sensors). Example scale-based biometrics include footlength, foot width, foot shape, toe print, weight, voice recognition,facial recognition, a passcode tapped and/or picture drawn with a footof the user on the GUI of the user display, among other biometrics. Insome specific embodiments, a scale-based biometric includes a toe-print(e.g., similar to a finger print) that is recognized using a toe-printreader on the FUI of the scale. The toe print can be used as a secureidentification of the user. In other related embodiments, a biometric isidentified using a user device that is in communication with the scale.For example the biometric can include a finger print identified using atablet and/or a cellphone that is wired or wireless communication withthe scale. And, a wearable device, such as a ring, wristband, and/orankle bracelet can be used to positively identify a user, with orwithout biometrics.

In other related embodiments, the validation include comparing voicesounds captured from the user and/or pictures of the user captured usingthe scale to data within the patient profile. For example, the scale caninclude a speaker component and the processing circuitry 104 and thespeaker component can capture voice sounds from the user. In otherembodiments, the scale includes a camera circuitry and the processingcircuitry 104 and the camera circuitry capture pictures of the user,such as facial images to perform facial recognition techniques on. Theoutput circuit 106 outputs the voice sounds and/or pictures to theexternal circuitry 111. The external circuitry 111 can compare the voicesounds and/or pictures to the patient profile database 123 to identity acorresponding patient profile and to verify the user data corresponds tothe user associated with the patient profile.

In further specific embodiments, the validation includes comparingverification data, which is included in the user data, to data withinthe patient profile. Verification data can include a password (e.g., toetapped password or voice spoken password), a physical address, a userID, a security number, a picture selected on the user display, abarcode, an RFID scan, a communication from another circuitry, and acombination thereof. For example, a user device, such as a smart phoneand/or smart watch may send a user ID to the scale (e.g., password,finger print, or identification). Alternatively, the user inputs theverification data. For example, the data-procurement circuitry 138 caninclude input/output circuitry configured to capture the verificationfrom the user. The input/output by the user can include vocal, dataentry on the scale and/or an input/out circuitry, and/or data entered bythe user to another user device (and the other user device sends thedata to the scale). That is, in some embodiments, other user circuitry,including a communication circuit, provides the data indicative of theuser's identity to the scale.

The verification can be performed by the external circuitry 111 or bythe scale and the external circuity 111. For example, the processingcircuitry 104 of the scale can confirm identification of the user usingthe collected signals indicative of the user's identity and communicatesthe data indicative of the user's identity to the external circuitry111. The data can include a user ID and/or other metadata stored on thememory circuity of the scale, in some embodiments. The externalcircuitry 111 validates the cardio-related physiologic data asconcerning the user associated with the specific patient profile byidentifying the specific patient profile and correlating thecardio-related physiologic data with the specific patient profile.Alternatively, the processing circuitry 104 generates the dataindicative of the user's identity (but may not confirm identification).The external circuitry 111 validates the cardio-related physiologic dataas concerning the user by confirming identification of the user usingthe data indicative of the user's identity in response to identifyingthe patient profile (e.g., matching the user identity data to thepatient profile) and correlates the cardio-related physiologic data withthe patient profile.

The external circuitry 111, in response to the validation, automaticallyupdates the patient profile. An automatic update, as used herein,includes storing data associated with the user within the patientprofile without manual data entry by a human. The update includes a userweight and a cardiogram measurement collected by the scale and/ordetermined using user data collected by the scale. Although embodimentsare not so limited and the update can include various physiologicalparameters. In various embodiments, the user data includes physiologicparameters and/or data indicative of the physiologic parameters. Forexample, the processing circuitry 104 can determine the physiologicalparameters or the external circuitry 111 can. The physiologic parameter,in various embodiments, includes PWV, BCG, cardiac output, pre-ejectionperiod, stroke volume, arterial stiffness, respiration, and/or otherhealth information. The user data, in some embodiments, includes the rawforce signals, bodyweight, heartrate, balance, tremors, body mass indexand/or percentage, among other data.

The external circuitry 111 can determine additional physiologicalparameters and/or clinical indications of the user. The clinicalindication is determined using the cardio-related physiologic data andis stored in the specific patient profile for review by a physician. Asdiscussed further herein, the clinical indication is determined bycorrelating the user data with historically collected user data and/orsample census data, and therefrom, deriving the clinical indication.

The clinical indication and/or the physiological parameter may indicatean emergency situation. For example, the clinical indication and/or thephysiological parameter is compared to a threshold value and in responseto the clinical indication and/or the physiological parameter beingoutside the threshold value, a signal providing an alert is generated bythe external circuitry 111 and/or the processing circuitry 104 and sentto another circuitry. For example, the clinical indication and/or thephysiological parameter may indicate the user is having heart failure, aseizure, difficulty breathing, and fluid build-up, among otherindications. In some instances, the signal is sent from the externalcircuitry 111 to circuitry associated with a nurse station and/or thephysician such that another person is informed of the emergencysituation.

Although the present examples embodiments provided above are inreference to external circuitry performing the determination,embodiments in accordance with the present disclosure are not solimited. For example, the processing circuitry 104 of the scale candetermine the physiologic parameter while the user is standing on theplatform 101. Further, the scale can be used to perform a variety ofprocesses in addition or alternatively to checking in a patient. Asdescribed further herein, the scale can be located at user's home and/orin a commercial setting and can offer review of the scale obtain data bya physician or other health professional as a service. In otherembodiments, assessment circuitry can perform the described featuresdirected to determining physiological parameters, clinical indications,and updating patient profiles. The assessment circuitry can beintegrated with the scale and/or integrated with the external circuitry112.

In various related embodiments, the scale is used to perform a questionand answer session. For example, the scale can display questions usingthe user display 102, provides computer generated voice questions usinga speaker component, and/or outputs signals to another device (e.g.,such as a tablet at the physician's office, an application on a smartphone of the user, or a smart watch, etc.) that include the questions.The questions are used to identify symptoms and/or reasons why the useris visiting the physician. The answers input by the user are output tothe external circuitry 111 and used to update the specific patientprofile. The update, for instance, includes populating the data in thespecific user patient profile. In various embodiments, the externalcircuitry uses the input data to determine the clinical indicationand/or to further refine the clinical indication stored. In variousspecific embodiments, voice input/output circuitry can be used toperform the question and answer session.

In accordance with various embodiments, although not illustrated by FIG.1a , the apparatus includes an additional sensor circuitry that isexternal to the scale. The additional sensor circuitry can include acommunication circuit and is configured and arranged to engage the userwith electrical signals and collect therefrom signals indicative of anECG of the user. The sensor circuitry may include and/or be correlatedwith processing circuitry and is configured to derive an ECG from thecollected signals. The sensor circuitry communicates the ECG to theexternal circuitry 111 and the scale can communicate a BCG to theexternal circuitry 111.

FIG. 1b shows an example of automatically updating a patient profileusing an apparatus consistent with aspects of the present disclosure.The apparatus illustrated by FIG. 1b can include the apparatus,including the platform 101 and user-display 102, as previouslyillustrated and discussed with regard to FIG. 1a . As illustrated, theapparatus includes a platform, a user display, data-procurementcircuitry 138, and processing circuitry 104. The data-procurementcircuitry 138 includes force sensor circuitry and a plurality ofelectrodes (e.g., the physiologic sensors 108) which are integrated withthe data-procurement circuitry 138. The processing circuitry 104includes a CPU and a memory circuit with user-corresponding data storedin the memory circuit. As previously discussed, the scale includes anoutput circuit to send the user data to external circuitry 111. Theexternal circuitry 111 can receive the user data and automaticallyupdate a specific patient profile associated with the user using theuser data.

For example, as illustrated by FIG. 1b , the scale at block 116 waitsfor a user to stand on the platform. Staff and/or other personal, suchas a nurse in the room or a reception can instruct the user to stand onthe scale when in the room or when the user enters the room. In variousembodiments, in response to the user standing on and/or approaching thescale, the apparatus obtains identification data to identify the user.Example identification data, as discuss further herein with regard toFIG. 2 a, includes the data indicative of the user's identity. In otherembodiments, the scale is located in the dwelling of the user or in acommercial setting. The user may stand on the scale without instructionsfrom other personal.

At block 117, the apparatus, using the processing circuitry 104,optionally confirms identification of the user when the user is standingon the platform and/or as the user approaches the platform. Theidentification, in various embodiments, is based on the identificationdata and/or user data. For example, the processing circuitry 104compares the identification data to stored user-corresponding data toconfirm identification of the user. In some embodiments, in response tothe confirmation, collected signals indicative of cardio-physiologicalmeasurements, as discussed below, are correlated with the identificationdata (e.g., metadata and/or a user ID). Further, in some embodiments,additional user-corresponding data is obtained in response to the userstanding on and/or approaching the platform.

In response to the user standing on the scale, the scale collectssignals indicative of cardio-physiological measurements (e.g., forcesignals). The processing circuitry 104, at block 118, processes thesignals to generate cardio-related physiologic data manifested as userdata and outputs the user data to the external circuitry 111. In variousembodiments, the processing includes adding (and later storing) datawith a time stamp indicating a time at about when the physiologicparameter data is obtained.

In accordance with a number of embodiments, the scale performs aquestion and answer session. For example, the data-procurement circuitry138 and the processing circuitry 104 (in addition to the user display, aspeaker component, and/or a camera circuitry) provide a number ofquestions in a question and answer session to identify symptoms and/orreasons that the user is visiting the physician, and which mayoptionally include the use of voice input/output circuitry.

The scale and/or external circuitry 111 can estimate a height or otherrelevant distance of the user. For example, the scale includes and/or isin communication with a physical arm. The physical arm is connected tothe scale and used to measure a height of the user. The measurement canbe digital and/or another person can assist and can verbally input themeasurement to the scale. Similarly, the estimated height or distancecan occur by the user and/or another person measuring and inputting themeasurement to the scale. In some embodiments, the user inputs(verbally, digitally, with another device) an estimate of their heightto the scale. In various embodiments, the estimation includes using lookup tables and at least one of a sensor on the user's finger and a headsensor on the user's head.

In accordance with various embodiments, a relevant distance isdetermined by the scale instructing the user to place their hand at aparticular location, such as their waist. For example, the instructioncan include a verbal instruction using a speaker component, a writteninstruction using the user display of the scale or a user display ofanother user device, and/or a picture on the user display of the scaleor of another user device. The scale includes a light source and,responsive to the instruction, outputs a light source from the scaletoward the location of the user's hand. Further, the scale determinesthe relevant distance based on a return from the light source reflectingback from the patient's hand.

At block 119, the scale displays data to the user via the user display.The scale can display the user's weight, verify responses to thequestion and answer session, collected signals, verify the identity ofthe user, among other data. The output circuit of the scale outputs boththe user data indicative of the user's identity and thecardio-physiologic measurements, and question and answer data to theexternal circuitry 111. The external circuitry automatically populatesthe question and answer data in the specific patient profile.

The external circuitry 111 receives the user data and, at block 121,validates the user data as corresponding to the user associated with aspecific patient profile using the data indicative of the user'sidentity. At block 122, the external circuitry 111 updates the userprofile using the user data, such as body weight and a cardiogrammeasurement. In various embodiments, the external circuitry 111 (and/orthe scale) further processes the data (as illustrated by the dashedarrow pointed to block 118). For example, the external circuitry 111 orthe scale determines at least one physiologic parameter using the userdata. Example physiologic parameters includes PWV, BCG, respiration,arterial stiffness, cardiac output, pre-ejection period, stroke volume,and a combination thereof. The external circuitry 111 then outputs thephysiologic parameter. The output is to the scale for display, such asillustrated at block 119 and/or to the patient profile database 123.Thereby, the physiological parameter or other clinical indication isused to further update the specific patient profile.

Further, thereby, in various embodiments, the external circuitry 111determines additional physiological parameters, clinical indications,and/or additional health information. For example, the determinedphysiologic parameter can include an ECG and the external circuitry 111can determine a BCG using the ECG. Alternatively and/or in addition, theexternal circuitry 111 can determine a health status of the user usingthe determined physiologic parameter, such as a condition or treatment.

As previously discussed, in accordance with a number of embodiments, thescale including the processing circuitry 104 provides a number ofquestions to the user. The questions can be provided via a speakercomponent of the scale outputting computer generated natural voice (viaa natural language interface), displaying the questions on the userdisplay, and/or outputting the questions to another user-device. Invarious embodiments, the questions include asking if the user isinterested in additional health information and if the user hasparticular categories of interest. In various embodiments, thecategories of interest include a set of demographics, disorders,diseases, and/or symptom, drugs, treatments that the user is interested,and/or other topics. The scale provides the input to the externalcircuitry 111 and the external circuitry 111 derives additional healthinformation for the user. The additional health information can includea table that corresponds to the categories of interest and/orcorresponds to the physiological parameter and/or clinical indicationsdetermined without providing any specific values and/or indicationrelated to the physiological parameter. The user is provided theadditional health information by the external circuitry 111 outputtingthe information to the scale and/or another user-device, and the scaleand/or other user-device displays the information. In variousembodiments, the information is printed by the user. In variousrelated-aspects, the scale using the processing circuitry 104 generatesthe additional health information instead of the external circuitry 111.

The additional health information is generated, in various embodiments,by comparing and/or correlating the categories of interest to raw dataobtained by the data-procurement circuitry 138 or the user data tohistorical user data captured over a period of time. In variousembodiments, the correlation/comparison include comparing statisticaldata of a sample census pertinent to the categories of interest and theat least one physiological parameter. The statistical data of a samplecensus includes data of other users that are correlated to thecategories of interest. In such instances, the additional healthinformation can include a comparison of data measured while the user isstanding on the platform to sample census data. In other relatedembodiments, the correlation/comparison includes comparing statisticaldata of a sample census pertinent to the categories of interest andvalues of the least one physiological parameter of the sample census. Insuch instances, the additional health information includes averagephysiological parameter values of the sample census that is set by theuser, via the categories of interest, and may not include actual valuescorresponding to the user.

For example, if the categories of interest are demographic categories,the additional health information can include various physiologicalparameter values of average users in the demographic categories and/orvalues of average users with a clinical indication that correlates to aphysiological parameter of the user. Alternatively and/or in addition,the additional health information can include general medical insightsrelated to the categories of interest. For example, “Did you know if youare over the age of 55 and have gained 15 pounds, you are at risk for aparticular disease/disorder?” The scale can ask the user if the userwould like to include this factor or disease in their categories ofinterest to dynamically update the categories of interest of the user.The physician of the user can be notified of the user's interest and/orcan be provided a copy of the additional health information. Forexample, the physician may go over the additional health informationwith the user during an appointment to provide further clarity.

Various categories of interest, in accordance with the presentdisclosure, include demographics of the user, disorders, diseases,symptoms, prescription or non-prescription drugs, treatments, pastmedical history, family medical history, genetics, life style (e.g.,exercise habits, eating habits, work environment), among othercategories and combinations thereof. In a number of embodiments, variousphysiological factors can be an indicator for a disease and/or disorder.For example, an increase in weight, along with other factors, canindicate an increased risk of atrial fibrillation. Further, atrialfibrillation is more common in men. However, symptoms of variousdisorders or disease can be different depending on categories ofinterest (e.g., atrial fibrillation symptoms can be different betweenmen and women). For example, in women, systolic blood pressure isassociated with atrial fibrillation. In other instances, sleep apnea maybe assessed via an ECG and can be correlated to weight of the user.Furthermore, various cardiac conditions can be assessed using an ECG.For example, atrial fibrillation can be characterized and/or identifiedin response to a user having indistinguishable or fibrillating p-waves,and indistinguishable baseline/inconsistent beat fluctuations. Atrialflutter, by contrast, can be characterized by having indistinguishablep-wave, variable heart rate, having QRS complexes, and a generallyregular rhythm. Ventricular tachycardia (VT) can be characterized by arate of greater than 120 beats per minute, and short or broad QRScomplexes (depending on the type of VT). Atrio-Ventricular (AV) blockcan be characterized by PR intervals that are greater than normal (e.g.,a normal range for an adult is generally 0.12 to 0.20 seconds),normal-waves, QRS complexes can be normal or prolong shaped, and thepulse can be regular (but slow at 20-40 beats per minute). For morespecific and general information regarding atrial fibrillation and sleepapnea, reference is made herein tohttps://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/atrial-fibrillation/and http://circ.ahajournals.org/content/118/10/1080.full, which arefully incorporated herein for their specific and general teachings.Further, other data and demographics that are known and/or are developedcan be added and used to derive additional health information.

For example, the categories of interest for a particular user caninclude a change in weight, age 45-55, and female. The scale obtains rawdata using the data-procurement circuitry 138 and the categories ofinterest from the user. The scale outputs the raw data and categories ofinterest to the external circuitry 111 and the external circuitry 111correlates the categories of interest to the raw data and derivesadditional health information therefrom. Further, the external circuitry111, over time, historically collects and correlates the categories ofinterest of the user and data from the data-procurement circuitry usingthe specific patient profile of the user. The external circuitry 111, invarious embodiments, sends the data to a physician and/or additionalhealth information to the user (to print and/or otherwise view).

The external circuitry 111 can control access to the data stored in thepatient profile. For example, the external circuitry 111 allows accessto the physiologic parameter and/or clinical indications to a physicianand/or does not allow access to the physiologic parameter and/or theclinical indication to the user.

In a number of embodiments, the external circuitry 111 outputs variousdata. For example, the external circuitry 111 includes an outputcircuity to output a signal to other circuitry. The signal, in someembodiments, is output to circuitry associated with the physician,nurses, and/or other staff that is indicative of completion of acheck-in process and/or that the user is ready to be seen by thephysician. The signal is output in response to the update of thespecific user profile. In various embodiments, the signal includes anindication of a clinical indication or data containing the clinicalindication, physiological parameters and/or other data. The physicianmay review the data in the signal and/or log-in to the specific patientprofile and review the data prior to seeing the user and/or at thebeginning of the appointment. Alternatively and/or in addition, thephysiological parameters and/or various other health information is sentto circuitry associated with the user (e.g., the scale for displayand/or other user circuitry, such as a cellphone).

In some embodiments, an alert is sent in response to the clinicalindication and/or a physiological parameter being outside a thresholdvalue. For example, in response to a clinical indication that indicatesthe user is experience heart failure, a signal containing an alert issent to circuitry of the physician, hospital, nurse station, etc.

FIG. 1c shows an example of a scale wireless communicating with externalcircuitry consistent with aspects of the present disclosure. The scaleis configured to monitor signals and/or data indicative of physiologicparameters of the user while the user is standing on the platform 101and communicate the signals and/or data to the external circuitry 111for automatically updating a patient profile.

As discussed above, a scale in various embodiments includes a platform101, a user display 102, processing circuitry 104 include a plurality ofelectrodes, and output circuitry. The output circuitry sends user datato the external circuitry 111 that is not integrated with the scale. Thescale communicates user data wirelessly (and/or via the cloud 129) toand from the external circuitry 111. For example, the external circuitry111 validates the user data sent from the scale as corresponding to auser associated with a specific user profile and updates the userprofile using the user data. In some embodiments, the external circuitry111 optionally controls access to the user data by storing the user dataand data determined using the user data in a database corresponding withand/or integrated with the external circuitry 111. Alternatively and/orin addition (such as, in response to determining the user can access theparameter) the external circuitry 111 outputs portions of the user datato the scale for display and/or to another user circuitry for displayand/or storage.

In various embodiments, the scale outputs user input data that providesan indication that the user is interested in additional healthinformation and various categories of interest. As previously discussed,the categories of interest can include demographics of interest,symptoms of interest, disorders of interest, diseases of interest, drugsof interest, treatments of interest, etc. The additional healthinformation can be derived by the external circuitry 111 and provided tothe scale (or other user circuitry) that correlates to the category ofinterest and a physiological parameter of the user.

For example, as illustrated by FIG. 1 c, the user provides userinput/outputs to the scale. The inputs/outputs include the categories ofinterest. The scale obtains signals using the data-procurement circuitryand outputs user-weight to the user. Further, the scale outputsscale-based physiological raw data (e.g., the collected signalsmanifested as user-data indicative of the user's identity andcardio-physiological measurements). As illustrated, the output caninclude a wireless communication to the external circuitry 111 using acloud system 129. The external circuitry 111 validates the raw data asconcerning a specific user and updates a patient profile of the specificuser. In various embodiments, the external circuitry 111 determinesclinical indications of the user and/or other additional healthinformation by correlating the raw data with the categories of interestand outputs the additional health information. For example, the externalcircuitry 111 outputs the additional health information to the scaleand/or another user circuitry using the cloud system 129 and/or anotherwireless communication.

In a number of embodiments, the external circuitry 111 provides (e.g.,determines) one or more clinical indications by processing the userdata, such as determining a physiologic parameter as discussed infurther detail herein. The clinical indication include PWV, BCG,respiration, arterial stiffness, cardiac output, pre-ejection period,stroke volume, diagnosis, conditions, risk factors, among other healthinformation. The external circuitry 111 provides the clinicalindication, in some embodiments, by updating the patient profile of theuser with the received user data and/or the clinical indication.

In various related embodiments, the external circuitry 111 determinesadditional health information and provides the additional healthinformation to the scale for display to the user. The additional healthinformation can be indicative of the physiological parameter and cancorrelate to categories of interest provided by the user. The categoriesof interest can be provided at a different time, the same time and/orfrom the scale. In various embodiments, the additional healthinformation is based on historical user-data. For example, theadditional health information (e.g., a table) provided can include acorrelation to the category of interest and the user-data over time.

The external circuitry can control access to the patient profile and/orthe data. The control of access includes allowing access to thephysiological parameter and/or clinical indications and the user data toa physician corresponding to the user for information. Further, thecontrol includes not allowing access to the physiological parametersand/or clinical indications to the user. In various embodiments, theuser is allowed to access the user data in the profile and the scale candisplay portions of the user data and/or other non-regulated data.Additionally, the external circuitry 111 may not allow access to theprofile and/or any data corresponding to the profile to non-qualifiedpersonal, such as other users. In various embodiments, the user isallowed access the physiological parameter in response to interpretationby the physician and a prescription from the physician to access thephysiological parameter. Further, in some embodiments, a demographicmodel and/or other report is provided to the user in response to thephysiological parameter. For example, the user may not be allowed toview the physiological parameter but is provided generic informationcorresponding to other users with similar physiological parameter value.

The access is controlled, in various embodiments, using a verificationprocess. For example, in response to verifying identification of thephysician and/or the user, access to particular data can be provided.The verification can be based on a user sign in and password, apassword, biometric data, etc., and/or identification of the user usingthe scale (in which, the relevant data is sent to the scale or anotheruser device in response to the identification).

The physiological parameter can be provided as an additional service.For example, the user can obtain the information and/or have theirphysician interpret the information for a service fee. For example, theuser can use the scale and data stored thereon as part of an onlinedoctor visit. The service fee can include a one-time fee for a singleinterpretation, a monthly or yearly service fee, and/or can be a portionof a health care insurance fee (e.g., the user can purchase a healthcare plan that includes the service). In such embodiments, the physiciancorresponding to the user can access the physiological parameter and/orother user data in response to verification that the user has enabledthe service and verification of the identity of the physician.

The automatic update of the patient profile and further analysis by theexternal circuitry 111, for example, can result in a reduction of humanand computer resources to enter data as compared to manually enteringdata into the patient profile. The automatic update, thereby, can reducetime spent on entering data into the patient profile and reducefrustration with changing regulation. For example, circuitry of thescale and/or the external circuitry 111 can be updated with newquestions to ask and/or information to obtain in response to changes inregulations. Further, the update to the circuitry of the scale and/orthe external circuitry 111 can include a mapping of old data (which mayhave been coded differently) to new data to correlate the user dataobtain over time. Asking questions to the user can prompt the user toremember issues and, in some instances, can be in response to measureddata. For example, the user data may indicate the user has a heartcondition and the scale, in response, asks questions regarding symptomsor lifestyle habits that are correlated with the heart condition. And,by provided the further analysis to the physician before or during theappointment, the physician can verify potential health issues anddiscuss the same with the user during the same appointment. Suchinformation can include life-style suggestions, explanation for how touse the prescribed medicine and/or why it is prescribed, and/or otheradvice, such as symptoms that the user should watch for. In someembodiments, in response to the clinical indication or data that isoutside a threshold, the scale is used to provide an alert indicating apotential medical emergency.

FIG. 1d shows an example of apparatus including a plurality of scalesand external circuitry consistent with aspects of the presentdisclosure. As illustrated, the apparatus includes a plurality of scales131-1, 131-2 . . . 131-P (herein generally referred to as “the scales131”) and external circuitry 111. Each scale can include the scale,including the platform 101 and user-display 102, as previouslyillustrated and discussed with regard to FIG. 1a . Thereby, each scaleincludes a platform, data-procurement circuitry 1 including force-sensorcircuitry and plurality of electrodes, processing circuitry to receivecollected signals from the data-procurement circuitry and, in response,derive and output user data to the external circuitry 111. Theprocessing circuitry includes a CPU and a memory circuit withuser-corresponding data stored in the memory circuit. The user data, invarious embodiments, is automatically sent from the scales 131 to theexternal circuitry 111.

In various embodiments, the apparatus is used to automatically updatepatient profiles of a plurality of users. The scales 131, for example,correspond to the plurality of users. For example, each scale, at block116 waits for a user to stand on the platform. In response to the userstanding on the respective scale, the respective scale collects signalsindicative of an identity of the user and cardio-physiologicalmeasurements (e.g., force signals). The processing circuitry, at block118, processes the signals and, in response, derives user data. Forexample, the processing circuitry 104, using the signals, derives andoutputs user data corresponding to a particular user to the outputcircuit. The output circuit receives the user data and outputs varioususer data. For example, at least a portion of the data is output to theuser display of the scale, and, at block 119, each scale displays datato the user. The displayed data includes a body weight measured usingthe scale, among other data. Further, the output circuit outputs theuser data to the external circuitry 111.

In response to receiving the user data from the plurality of scales 131,at block 121, the external circuitry 111 validates respective user dataas corresponding to respective user associated with patient profiles,updates the patient profiles using the respective user data, and,optionally, determines clinical indications. In various embodiments, theexternal circuitry includes computer-readable instructions executed toperform the various functions. For example, as illustrated by FIG. 1d ,the external circuitry 111 includes validation logic 132 to validate theuser data, update logic 133 to update patient profiles, and clinicalindication logic 134 to determine clinical indications using the userdata and/or question and answer data.

For example, the external circuitry 111 receives the user-data thatcorresponds to the plurality users from the plurality of scales 131. Therespective user data is received at over-lapping times and/or separatetimes. In response to receiving the user data, the external circuitry111, at block 121, validates the user data as corresponding to the usersassociated with the respective patient profiles. The validation canoccur by comparing the user data to data in the patient profile database123. Further, at block 141, the external circuitry 111 determinesclinical indications using the user data and/or historical user data.For example, the external circuitry 111 includes and/or is incommunication with a clinical indication database 136. The clinicalindication database 136 includes various sample census data of otherusers having various clinical indications and/or physiological parametervalues and/or symptoms that are indicative of the clinical indication.The external circuitry 111 compares the user data to the clinicalindication database 136 to determine correlated clinical indication(s).At block 122, the external circuitry automatically updates therespective patient profiles in the patient profile database 123 thatcorrespond to the users and the user data received.

In accordance with various embodiments, the external circuitry 111outputs the clinical indication and/or other health information back tothe scale and/or another user device to display to the user. Further,the external circuitry optionally controls access to the patientprofiles. The control of access can include allowing access to thephysiological parameter (e.g., a clinical indication) and the user-datato at least one physician corresponding to at least one of the pluralityof users and for interpretation. Further, the control includes notallowing access to the physiological parameter(s) to the plurality ofusers (e.g., without a prescription). In various embodiments, the usersare allowed access to the user data in the profile and the scale candisplay portions of the user data and/or other non-regulated data. Invarious embodiments, a specific user among the plurality of users isallowed access to the physiological parameter corresponding to thespecific user in response to interpretation by a physician correspondingto the specific user and a prescription from the physician to access thephysiological parameter. Further, in some embodiments, a demographicmodel and/or other report is provided to one or more users in responseto the physiological parameter and/or categories of interest input bythe user. In various embodiments, the user data is compared againsthistorical user data for the same user and used to analyze if the user'scondition/treatment and risk is getting better or worse over time.

The user data can be collected and determined but the user is notallowed access to the features, such as access to the user data orservice related to the user data until government clearance is obtained.For example, the scale collects and stores the user data but does notdisplay or otherwise allow the user access to the user data untilclearance is obtained for each feature, which retrospectively enablesthe feature and/or service. Alternatively and/or in addition, thefeature and/or service is not provided until a weighted value isreceived (e.g., payment).

As such, and in accordance with various embodiments, the one or morescales 131 have the capability to send raw force signals using wirelesscommunications and/or over the Internet. The raw force signals are sentto the external circuitry 111, which may be an online database, whereadvanced processing is performed using processing resources that may bemore powerful than the scale. The external circuitry 111 processes theforce signals to determine the physiological parameters andautomatically updates the patient profiles using the physiologicalparameters. The user may access the one or more the physiologicalparameters corresponding to the user via a prescription from a physicianand/or a prescription service. The service provider can, for example,allow the user's physician to access the physiological parameter andother data for interpretation in response to the user paying a servicefee. In response to the service fee, the physician can interpret thedata and may prescribe access to the data, among other things. Theexternal circuitry 111 and/or online database/site can track user-datafor a plurality of users and from a plurality of scales and cancorrelate the user-data with a patient profile of the respective user.The patient profile of the user can be updated over time.

One or more of the plurality of scales 131 can be used by multipledifferent users. A subset or each of the different users can have dataoutput to the external circuitry 111 and/or one or more of the scales131 can be located at a location of a physician and/or other healthcareprofessional. The scale can operate in different operation modesdepending on the setting of the scale. The different modes, as furtherdescribed below, can include a consumer use mode, a professional usemode, and a combination use mode. The scale can default to a particularmode (e.g., consumer use mode), default based on user input, and/orbased use of the scale. In each of the modes, the scale can recognizethe particular user, such as based on a biometric as described above,and can output user data to external circuitry for updating a patientprofile corresponding to the user. In various embodiment, the externalcircuitry can diagnose the user and/or determine various risks factors.The external circuitry, depending on the particular mode and/oridentified user, provides access to the diagnosis and/or risks factordata to a health care professional and/or the user.

A consumer mode includes a scale as used and/or operated in a consumersetting, such as a dwelling. As a specific example, a scale is locatedin a dwelling with five different people. The external circuitry isremotely located from the dwelling and accessible by a physician. Eachof the five different people use the scale, and two of the five peoplehave previously provided inputs to the scale that indicate an interestin a service for a physician review of scale-based data and/or for avisiting the physician for healthcare services. For example, one or moreof the user previously activated access to the respective service, suchas via a service associated with a weighted value. As a specificexample, the service includes the physician periodically reviewing thedata and making recommendations, drug titrations and/or review, healthcoaching services, and/or visit to the physician (in which the user datais used to access the user when the user is physically located at thescale). The user data is obtained while the user is at home and canprovide a more complete view of the user (rather than just data when theuser is at the physician's office). The scale and/or external circuitrycan store the activation, automatically update the patient profile withthe user data, and provide a physician access to the patient profile ofthe user. The user may, in some embodiments, schedule an appointmentwith the physician for diagnosis, prescription, and/or other healthadvice services. The activation of the service can include a user inputindicative of user interest in the service and/or in visiting thephysician. In other embodiments, the health professional can activatethe service by inputting identification of the scale to the externalcircuitry, which then outputs a message to the scale to activate theservice. The scale and/or external circuitry can selectively trackparticular data and provide the data to the physician for further reviewas part of the service. In a specific example, the additional dataincludes a prescription for medication.

As a specific consumer use mode example, a first user has previouslyidentified an interest in providing user data to a physician and, whenthe first user stands on the scale, the scale identifies the first userusing a biometric, identifies activation of service for providing userdata to a physician, and outputs the user data to the externalcircuitry. The external circuitry uses the user data to automaticallyupdate the patient profile corresponding with the first user, which thephysician can use to diagnose the user (in person or remotely),prescribe prescriptions, recommend or prescribe different healthservices, recommend lifestyle changes, and/or change drug dosages (e.g.,drug titrations). A second user stands on the scale that has notidentified an interest in providing user data to a physician and,responsive to identifying the second user using a biometric, the scaleobtains user data and prompts the user to use a service provided by thephysician. The prompt can be for any user and/or in response toidentifying the user is at risk for a health condition. In specificembodiments, the prompt can include an advertisement for review of thedata by the physician and/or for visiting the physician. In response tothe second user providing an input indicating an interest in theservice, the scale outputs the user data to the external circuitryaccessible by the physician. If the second user is already a client ofthe physician, the external circuitry identifies an existing patientprofile corresponding with the user and updates the same. If the seconduser is not a client, the external circuitry generates a new patientprofile corresponding with the second user and updates the new patientprofile with the user data. As users in a consumer mode may be familiarwith one another (e.g., live together), the identification of the userby the scale can be based on weight, body-mass-index, and/or other data.Although embodiments are not so limited and the identification can bebased on other biometrics and/or passcodes.

In other instances the scale is used in a professional setting, such asa medical office, and/or in a professional mode. A professional modeincludes an operation of the scale as used and/or operated in aprofessional setting, such as a doctor's office, exercise facility,nursing home, etc. In a professional mode, the scale is used bydifferent users that may not be familiar with one another. The differentusers may have services with the professional to track and/or aggregatedata and/or to provide health information. In various embodiments, thescale is used to check-in the users for professional services. Forexample, the scale recognizes the users (using verification data),outputs user data obtained using the scale to external circuitry, andthe external circuitry updates a patient profile corresponding with theuser. In a number of embodiments, the scale asks the user variousquestions, such as reasons for seeing the professional and/or symptomsoccurring, and outputs the answers from the user as user data to theexternal circuitry. The external circuitry is accessible by theprofessional, whom can view the user data, which may include or indicatediagnosis information, prior to seeing the user for a service.

In some instances, a user can be provided additional health informationas service while waiting for the professional, such as while waiting tosee a doctor. The scale receives the additional health informationand/or clinical indication from the external circuitry and eitherdisplays the additional health information using a user interface of thescale and/or via direct communication (e.g., WiFi, Bluetooth, NFC) witha user device (e.g., cellphone, tablet) that is within a thresholddistance of the scale. Similar to the consumer mode, the scale canselectively provide the services by verifying the identity of the userusing a biometric. The identification can include higher-level biometricand/or identification than the consumer mode.

As a specific professional mode example, a scale is located at adoctor's office and is used to obtain data from multiple patients (e.g.,10 in a day, 500 in a year). When a patient checks-in, they stand on thescale and the scale-obtained data is output to external circuitry fordocument retention and/or other purposes. The external circuitryautomatically updates the patient profile corresponding with thespecific patient with user data obtained by the scale including weight,physiological data, and, optionally, answers to various questions, suchas to identify the reason for visiting the physician and/or symptoms.The scale can recognize the user standing on the platform usingverification data, such as a scale-obtained biometric. In variousembodiments, the external circuitry may output a message that identifiesspecific users expected to stand on the scale for the day, for a periodof time, and/or otherwise before the respective users stand on thescale. For example, the external circuitry outputs, to the scale,identification of the scheduled users (that have appointments) for theday at the beginning of the day and/or periodically. The output can beautomatic and/or based on a user input, such as a receptionist. In otherembodiments, the message is output by the external circuitry responsiveto the user beginning a check-in process. As a specific example, apatient may check-in at an emergency hospital or urgent care using akiosk, online, and/or with a receptionist with access to circuitry.Responsive to the user checking in, a message is output (from the kioskor other circuitry, such as a desktop computer, tablet, and/orcellphone) to the scale.

The scale can also be in a combination consumer/professional mode. Acombination consumer/professional mode includes a scale as used and/oroperated in a consumer setting for purposes and/or uses by aprofessional, and/or in a professional setting for purposes and/or usesby the consumer (e.g., use by the consumer outside of the professionalsetting and/or in addition to). As a specific example, a scale islocated at a user's dwelling and used by multiple family members. Afirst user of the family is diagnosed with a heart-related condition andthe doctor may offer a service to review data from the scale (andoptionally another user device) of the first user. When the other familymembers stand on the scale, the scale operates in the consumer mode. Theother family members may or may not have the service activated for thedoctor to review data and the scale operates via the consumer mode. Whenthe first user that is diagnosed with heart-related condition stands onthe scale, the scale recognizes the user and operates in a professionalmode or a combination mode. For example, the scale outputs aggregateddata from the scale to external circuitry that is accessible by thedoctor of the first user and the external circuitry automaticallyupdates a patient profile that corresponds to the first user.

Data provided to the user and/or the professional can default to bedisplayed on the user interface of the scale, the GUI of the userdevice, and/or a GUI of other external circuitry depending on the use ofthe scale. In a consumer mode and/or combination consumer/professionalmode, data can default to display on the user interface of the scale.The defaulted display of data can be revised by the user providinginputs to display the data on the GUI of a user device or a GUI ofanother external circuitry (e.g., a standalone CPU) and/or automaticallyby the scale based on past scale-based actions of the user. As aspecific example, a first user provided a user input to the scale todisplay data on the GUI of the user device multiple times (e.g., morethan a threshold number of times, such as five times). In response, thescale adjusts the defaulted display and outputs data to the GUI of theuser device. The display on the user interface of the scale and/or GUIof the user device (or other external circuitry) can include anindication of available clinical indication and/or the clinicalindication, among other displays. In a professional mode, the scale isnot owned by the user. The user may be uninterested in synchronizingtheir user device with the professional's scale. The display may defaultto the GUI of the user device to display an option to synchronize,and/or to override the synchrony. Alternatively, the display may defaultto the user interface of the scale to display an option to synchronizeand, responsive to user verification or authority to synchronize,defaults to display on the GUI of the user device. During thecombination consumer/professional mode, portions of scale-obtained datafor a particular user may default to display on external circuitry, suchas a standalone or server CPU that is accessible by the professional.

The remaining figures illustrate various ways to collect the physiologicdata from the user, electrode configurations, and alternative modes ofthe processing circuitry 104. For general and specific informationregarding the collection of physiologic data, electrode configurations,and alternative modes, reference is made to U.S. patent application Ser.No. 14/338,266 filed on Oct. 7, 2015, which is hereby fully incorporatedby references for its teachings.

FIG. 1e shows current paths 100 through the body of a user 105 standingon a scale 110 for the IPG trigger pulse and Foot IPG, consistent withvarious aspects of the present disclosure. Impedance measurements 115are measured when the user 105 is standing and wearing coverings overthe feet (e.g., socks or shoes), within the practical limitations ofcapacitive-based impedance sensing, with energy limits considered safefor human use. The measurements 115 can be made with non-clothingmaterial placed between the user's bare feet and contact electrodes,such as thin films or sheets of plastic, glass, paper or wax paper,whereby the electrodes operate within energy limits considered safe forhuman use. The IPG measurements can be sensed in the presence ofcallouses on the user's feet that normally diminish the quality of thesignal.

As shown in FIG. 1e , the user 105 is standing on a scale 110, where thetissues of the user's body will be modeled as a series of impedanceelements, and where the time-varying impedance elements change inresponse to cardiovascular and non-cardiovascular movements of the user.ECG and IPG measurements sensed through the feet can be challenging totake due to small impedance signals with (1) low SNR, and because theyare (2) frequently masked or distorted by other electrical activity inthe body such as the muscle firings in the legs to maintain balance. Thehuman body is unsteady while standing still, and constant changes inweight distribution occur to maintain balance. As such, cardiovascularsignals that are measured with weighing scale-based sensors typicallyyield signals with poor SNR, such as the Foot IPG and standing BCG.Thus, such scale-based signals require a stable and high qualitysynchronous timing reference, to segment individual heartbeat-relatedsignals for signal averaging to yield an averaged signal with higher SNRversus respective individual measurements.

The ECG can be used as the reference (or trigger) signal to segment aseries of heartbeat-related signals measured by secondary sensors(optical, electrical, magnetic, pressure, microwave, piezo, etc.) foraveraging a series of heartbeat-related signals together, to improve theSNR of the secondary measurement. The ECG has an intrinsically high SNRwhen measured with body-worn gel electrodes, or via dry electrodes onhandgrip sensors. In contrast, the ECG has a low SNR when measured usingfoot electrodes while standing on said scale platforms; unless the useris standing perfectly still to eliminate electrical noise from the legmuscles firing due to body motion. As such, ECG measurements at the feetwhile standing are considered to be an unreliable trigger signal (lowSNR). Therefore, it is often difficult to obtain a reliablecardiovascular trigger reference timing when using ECG sensorsincorporated in base scale platform devices. Both Inan, et al. (IEEETransactions on Information Technology in Biomedicine, 14:5, 1188-1196,2010) and Shin, et al. (Physiological Measurement, 30, 679-693, 2009)have shown that the ECG component of the electrical signal measuredbetween the two feet while standing was rapidly overpowered by theelectromyogram (EMG) signal resulting from the leg muscle activityinvolved in maintaining balance.

The accuracy of cardiovascular information obtained from weighing scalesis also influenced by measurement time. The number of beats obtainedfrom heartbeats for signal averaging is a function of measurement timeand heart rate. Typically, a resting heart rates range from 60 to 100beats per minute. Therefore, short signal acquisition periods may yielda low number of beats to average, which may cause measurementuncertainty, also known as the standard error in the mean (SEM). SEM isthe standard deviation of the sample mean estimate of a population mean.Where, SE is the standard error in the samples N, which is related tothe standard error or the population S. The following is an example SEfor uncorrelated noise:

${SE} = \frac{S}{\sqrt{N}}$

For example, a five second signal acquisition period may yield a maximumof five to eight beats for ensemble averaging, while a 10 second signalacquisition could yield 10-16 beats. However, the number of beatsavailable for averaging and SNR determination is usually reduced for thefollowing factors; (1) truncation of the first and last ensemble beat inthe recording by the algorithm, (2) triggering beats falsely missed bytriggering algorithm, (3) cardiorespiratory variability, (4) excessivebody motion corrupting the trigger and Foot IPG signal, and (5) loss offoot contact with the measurement electrodes.

Sources of noise can require multiple solutions for SNR improvements forthe signal being averaged. Longer measurement times increase the numberof beats lost to truncation, false missed triggering, and excessivemotion. Longer measurement times also reduce variability fromcardiorespiratory effects. If shorter measurement times (e.g., less than30 seconds) are desired for scale-based sensor platforms, sensingimprovements need to tolerate body motion and loss of foot contact withthe measurement electrodes.

The human cardiovascular system includes a heart with four chambers,separated by valves that return blood to the heart from the venoussystem into the right side of the heart, through the pulmonarycirculation to oxygenate the blood, which then returns to the left sideof the heart, where the oxygenated blood is pressurized by the leftventricles and is pumped into the arterial circulation, where blood isdistributed to the organs and tissues to supply oxygen. Thecardiovascular or circulatory system is designed to ensure oxygenavailability and is often the limiting factor for cell survival. Theheart normally pumps five to six liters of blood every minute duringrest and maximum cardiac output during exercise increases up toseven-fold, by modulating heart rate and stroke volume. The factors thataffect heart rate include autonomic innervation, fitness level, age andhormones. Factors affecting stroke volume include heart size, fitnesslevel, contractility or pre-ejection period, ejection duration, preloador end-diastolic volume, afterload or systemic resistance. Thecardiovascular system is constantly adapting to maintain a homeostasis(set point) that minimizes the work done by the heart to maintaincardiac output. As such, blood pressure is continually adjusting tominimize work demands during rest. Cardiovascular disease encompasses avariety of abnormalities in (or that affect) the cardiovascular systemthat degrade the efficiency of the system, which include but are notlimited to chronically elevated blood pressure, elevated cholesterollevels, edema, endothelial dysfunction, arrhythmias, arterialstiffening, atherosclerosis, vascular wall thickening, stenosis,coronary artery disease, heart attack, stroke, renal dysfunction,enlarged heart, heart failure, diabetes, obesity and pulmonarydisorders.

Each cardiac cycle results in a pulse of blood being delivered into thearterial tree. The heart completes cycles of atrial systole, deliveringblood to the ventricles, followed by ventricular systole deliveringblood into the lungs and the systemic arterial circulation, where thediastole cycle begins. In early diastole the ventricles relax and fillwith blood, then in mid-diastole the atria and ventricles are relaxedand the ventricles continue to fill with blood. In late diastole, thesinoatrial node (the heart's pacemaker) depolarizes then contracting theatria, the ventricles are filled with more blood and the depolarizationthen reaches the atrioventricular node and enters the ventricular sidebeginning the systole phase. The ventricles contract and the blood ispumped from the ventricles to arteries.

The ECG is the measurement of the heart's electrical activity and isdescribed in five phases. The P-wave represents atrial depolarization,the PR interval is the time between the P-wave and the start of the QRScomplex. The QRS wave complex represents ventricular depolarization. TheQRS complex is the strongest wave in the ECG and is frequently used as atiming reference for the cardiovascular cycle. Atrial repolarization ismasked by the QRS complex. The ST interval represents the period of zeropotential between ventricular depolarization and repolarization. Thecycle concludes with the T-wave representing ventricular repolarization.

The blood ejected into the arteries creates vascular movements due tothe blood's momentum. The blood mass ejected by the heart first travelsheadward in the ascending aorta and travels around the aortic arch thentravels down the descending aorta. The diameter of the aorta increasesduring the systole phase due to the high compliance (low stiffness) ofthe aortic wall. Blood traveling in the descending aorta bifurcates inthe iliac branch which transitions into a stiffer arterial region due tothe muscular artery composition of the leg arteries. The blood pulsationcontinues down the leg and foot. Along the way, the arteries branch intoarteries of smaller diameter until reaching the capillary beds where thepulsatile blood flow turns into steady blood flow, delivering oxygen tothe tissues. The blood returns to the venous system terminating in thevena cava, where blood returns to the right atrium of the heart for thesubsequent cardiac cycle.

Surprisingly, high quality simultaneous recordings of the Leg IPG andFoot IPG are attainable in a practical manner (e.g., a user operatingthe device correctly simply by standing on the impedance body scale footelectrodes), and can be used to obtain reliable trigger fiducial timingsfrom the Leg IPG signal. This acquisition can be far less sensitive tomotion-induced noise from the Leg EMG that often compromises Leg ECGmeasurements. Furthermore, it has been discovered that interleaving thetwo Kelvin electrode pairs for a single foot, result in a design that isinsensitive to foot placement within the boundaries of the overallelectrode area. As such, the user is not constrained to comply withaccurate foot placement on conventional single foot Kelvin arrangements,which are highly prone to introducing motion artifacts into the IPGsignal, or result in a loss of contact if the foot is slightlymisaligned. Interleaved designs begin when one or more electrodesurfaces cross over a single imaginary boundary line separating anexcitation and sensing electrode pair. The interleaving is configured tomaintain uniform foot surface contact area on the excitation and sensingelectrode pair, regardless of the positioning of the foot over thecombined area of the electrode pair.

Various aspects of the present disclosure include a weighing scaleplatform (e.g., scale 110) of an area sufficient for an adult of averagesize to stand comfortably still and minimize postural swaying. Thenominal scale length (same orientation as foot length) is 12 inches andthe width is 12 inches. The width can be increased to be consistent withthe feet at shoulder width or slightly broader (e.g., 14 to 18 inches,respectively).

FIG. 1f is a flow chart depicting an example manner in which auser-specific physiologic meter or scale may be programmed in accordancewith the present disclosure. This flow chart uses a computer processorcircuit (or CPU) along with a memory circuit shown herein as userprofile memory 146 a. The CPU operates in a low-power consumption mode,which may be in off mode or a low-power sleep mode, and at least oneother higher power consumption mode of operation. The CPU can beintegrated with presence and/or motion sense circuits, such as a passiveinfrared (PIR) circuit and/or pyroelectric PIR circuit. In a typicalapplication, the PIR circuit provides a constant flow of data indicativeof amounts of radiation sensed in a field of view directed by the PIRcircuit. For instance, the PIR circuit can be installed behind an uppersurface which is transparent to infrared light (and/or other visiblelight) of the platform and installed at an angle so that the motion ofthe user approaching the platform apparatus is sensed. Radiation fromthe user, upon reaching a certain detectable level, wakes up the CPUwhich then transitions from the low-power mode, as depicted in block140, to a regular mode of operation. Alternatively, the low-power modeof operation is transitioned from a response to another remote/wirelessinput used as a presence to awaken the CPU. In other embodiments, usermotion can be detected by an accelerometer integrated in the scale orthe motion is sensed with a single integrated microphone or microphonearray, to detect the sounds of a user approaching.

From block 140, flow proceeds to block 142 where the user or otherintrusion is sensed as data received at the platform apparatus. At block144, the circuitry assesses whether the received data qualifies asrequiring a wake up. If not, flow turns to block 140. If however, wakeup is required, flow proceeds from block 144 to block 146 where the CPUassesses whether a possible previous user has approached the platformapparatus. This assessment is performed by the CPU accessing the userprofile memory 146A and comparing data stored therein for one or moresuch previous users with criteria corresponding to the received datathat caused the wake up. Such criteria includes, for example, the timeof the day, the pace at which the user approached the platform apparatusas sensed by the motion detection circuitry, the height of the user asindicated by the motion sensing circuitry and/or a camera installed andintegrated with the CPU, and/or more sophisticated bio-metric dataprovided by the user and/or automatically by the circuitry in theplatform apparatus.

As discussed herein, such sophisticated circuitry can include one ormore of the following user-specific attributes: foot length, type offoot arch, weight of user, and/or manner and speed at which the usersteps onto the platform apparatus, or sounds made by the user's motionor by user speech (e.g., voice). In some embodiments, facial orbody-feature recognition may also be used in connection with the cameraand comparisons of images therefrom to images in the user profilememory.

From block 146, flow proceeds to block 148 where the CPU obtains and/orupdates user corresponding data in the user profile memory. As alearning program is developed in the user profile memory, each accessand use of the platform apparatus is used to expand on the data andprofile for each such user. From block 148, flow proceeds to block 150where a decision is made regarding whether the set of electrodes at theupper surface of the platform are ready for the user, such as may bebased on the data obtained from the user profile memory. For example,delays may ensue from the user moving his or her feet about the uppersurface of the platform apparatus, as may occur while certain data isbeing retrieved by the CPU (whether internally or from an externalsource such as a program or configuration data updates from the Internetcloud) or when the user has stepped over the user-display. If theelectrodes are not ready for the user, flow proceeds from block 150 toblock 152 to accommodate this delay.

Once the CPU determines that the electrodes are ready for use while theuser is standing on the platform surface, flow proceeds to block 160.Stabilization of the user on the platform surface may be ascertained byinjecting current through the electrodes via the interleaved arrangementthereof. Where such current is returned via other electrodes for aparticular foot and/or foot size, and is consistent for a relativelybrief period of time, for example, a few seconds, the CPU can assumethat the user is standing still and ready to use the electrodes andrelated circuitry. At block 160, a decision is made that both the userand the platform apparatus are ready for measuring impedance and certainsegments of the user's body, including at least one foot.

The remaining flow of FIG. 1f includes the application and sensing ofcurrent through the electrodes for finding the optimal electrodes (162)and for performing impedance measurements (block 164). Thesemeasurements are continued until completed at block 166 and all suchuseful measurements are recorded and are logged in the user profilememory for this specific user, at block 168. At block 172, the CPUgenerates output data to provide feedback as to the completion of themeasurements and, as can be indicated as a request via the user profilefor this user, as an overall report on the progress for the user andrelative to previous measurements made for this user has stored in theuser profile memory. Such feedback may be shown on the user-display,through a speaker with co-located apertures in the platform for audiblereception by the user, and/or by vibration circuitry which, uponvibration under control of the CPU, the user can sense through one orboth feet while standing on the scale. From this output at block 172,flow returns to the low power mode as indicated at block 174 with thereturn to the beginning of the flow at the block 140.

FIG. 2a shows an example of the insensitivity to foot placement 200 onscale electrode pairs 205/210 with multiple excitation paths 220 andsensing current paths 215, consistent with various aspects of thepresent disclosure. An aspect of the platform is that it has a thicknessand strength to support a human adult of at least 200 pounds withoutfracturing, and another aspect of the device platform is comprised of atleast six electrodes, where the first electrode pair 205 is solid andthe second electrode pair 210 are interleaved. Another aspect is thefirst and second interleaved electrode pairs 205/210 are separated by adistance of at least 40+/−5 millimeters, where the nominal separation ofless than 40 millimeters has been shown to degrade the single Foot IPGsignal. Another key aspect is the electrode patterns are made frommaterials with low resistivity such as stainless steel, aluminum,hardened gold, ITO, index matched ITO (IMITO), carbon printedelectrodes, conductive tapes, silver-impregnated carbon printedelectrodes, conductive adhesives, and similar materials with resistivitylower than 300 ohms/sq. The resistivity can be below 150 ohms/sq. Theelectrodes are connected to the electronic circuitry in the scale byrouting the electrodes around the edges of the scale to the surfacebelow, or through at least one hole in the scale (e.g., a via hole).

Suitable electrode arrangements for dual Foot IPG measurements can berealized in other embodiments. In certain embodiments, the interleavedelectrodes are patterned on the reverse side of a thin piece (e.g., lessthan 2 mm) of high-ion-exchange (HIE) glass, which is attached to ascale substrate and used in capacitive sensing mode. In certainembodiments, the interleaved electrodes are patterned onto a thin pieceof paper or plastic which can be rolled up or folded for easy storage.In certain embodiments, the interleaved electrodes are integrated ontothe surface of a tablet computer for portable IPG measurements. Incertain embodiments, the interleaved electrodes are patterned onto akapton substrate that is used as a flex circuit.

In certain embodiments, the scale area has a length of 10 inches with awidth of eight inches for a miniature scale platform. Alternatively, thescale may be larger (up to 36 inches wide) for use in bariatric classscales.

In the present disclosure, the leg and foot impedance measurements canbe simultaneously carried out using a multi-frequency approach, in whichthe leg and foot impedances are excited by currents modulated at two ormore different frequencies, and the resulting voltages are selectivelymeasured using a synchronous demodulator as shown in FIG. 3 a. Thishomodyning approach can be used to separate signals (in this case, thevoltage drop due to the imposed current) with very high accuracy andselectivity.

This measurement configuration is based on a four-point configuration inorder to minimize the impact of the contact resistance between theelectrode and the foot, a practice well-known in the art of impedancemeasurement. In this configuration the current is injected from a set oftwo electrodes (the “injection” and “return” electrodes), and thevoltage drop resulting from the passage of this current through theresistance is sensed by two separate electrodes (the “sense”electrodes), usually located in the path of the current. Since the senseelectrodes are not carrying any current (by virtue of their connectionto a high-impedance differential amplifier), the contact impedance doesnot significantly alter the sensed voltage.

In order to sense two distinct segments of the body (the legs and thefoot), two separate current paths are defined by electrode positioning.Therefore two injection electrodes are used, each connected to a currentsource modulated at a different frequency. The injection electrode forleg impedance is located under the plantar region of the left foot,while the injection electrode for the Foot IPG is located under the heelof the right foot. Both current sources share the same return electrodelocated under the plantar region of the right foot. This is anillustrative example. Other configurations may be used.

The sensing electrodes can be localized so as to sense the correspondingsegments. Leg IPG sensing electrodes are located under the heels of eachfoot, while the two foot sensing electrodes are located under the heeland plantar areas of the right foot. The inter-digitated nature of theright foot electrodes ensures a four-point contact for proper impedancemeasurement, irrespectively of the foot position, as already explained.

FIG. 2b shows an example of electrode configurations, consistent withvarious aspects of the disclosure. As shown by the electrodeconnections, in some embodiments, ground is coupled to the heel of onefoot of the user (e.g., the right foot) and the foot current injection(e.g., excitation paths 220) is coupled to the toes of the respectiveone foot (e.g., toes of the right foot). The leg current injection iscoupled to the toes of the other foot (e.g., toes of the left foot).

FIG. 2c shows an example of electrode configurations, consistent withvarious aspects of the disclosure. As shown by the electrodeconnections, in some embodiments, ground is coupled to the heel of onefoot of the user (e.g., the right foot) and the foot current injection(e.g., excitation paths 220) is coupled to the toes of the one foot(e.g., toes of the right foot). The leg current injection is coupled tothe heels of the other foot of the user (e.g., heels of the left foot).

FIGS. 3a-3b show example block diagrams depicting the circuitry forsensing and measuring the cardiovascular time-varying IPG raw signalsand steps to obtain a filtered IPG waveform, consistent with variousaspects of the present disclosure. The example block diagrams shown inFIGS. 3a-3b are separated in to a leg impedance sub-circuit 300 and afoot impedance sub-circuit 305.

Excitation is provided by way of an excitation waveform circuit 310. Theexcitation waveform circuit 310 provides a stable amplitude excitationsignal by way of various wave shapes of various, frequencies, such asmore specifically, a sine wave signal (as is shown in FIG. 3a ) or, morespecifically, a square wave signal (as shown in FIG. 3b ). Thisexcitation waveform (of sine, square, or other wave shape) is fed to avoltage-controlled current source circuit 315 which scales the signal tothe desired current amplitude. The generated current is passed through adecoupling capacitor (for safety) to the excitation electrode, andreturned to ground through the return electrode (grounded-loadconfiguration). Amplitudes of 1 and 4 mA peak-to-peak are typically usedfor Leg and Foot IPGs, respectively.

The voltage drop across the segment of interest (legs or foot) is sensedusing an instrumentation differential amplifier (e.g., Analog DevicesAD8421) 320. The sense electrodes on the scale are AC-coupled to theinputs of the differential amplifier 320 (configured for unity gain),and any residual DC offset is removed with a DC restoration circuit (asexemplified in Burr-Brown App Note Application Bulletin, SBOA003, 1991,or Burr-Brown/Texas Instruments INA118 datasheet). Alternatively, afully differential input amplification stage can be used whicheliminates the need for DC restoration. The signal is then demodulatedwith a phase-sensitive synchronous demodulator circuit 325. Thedemodulation is achieved in this example by multiplying the signal by 1or −1 synchronously in-phase with the current excitation. Suchalternating gain is provided by an operational amplifier (op amp) and ananalog switch (SPST), such as an ADG442 from Analog Devices). Morespecifically, the signal is connected to both positive and negativeinputs through 10 kOhm resistors. The output is connected to thenegative input with a 10 kOhm resistor as well, and the switch isconnected between the ground and the positive input of the op amp. Whenopen, the gain of the stage is unity. When closed (positive inputgrounded), the stage acts as an inverting amplifier with a gain of −1.Further, fully differential demodulators can alternatively be used whichemploy pairs of DPST analog switches whose configuration can provide thebenefits of balanced signals and cancellation of charge injectionartifacts. Alternatively, other demodulators such as analog multipliersor mixers can be used. The in-phase synchronous detection allows thedemodulator to be sensitive to only the real, resistive component of theleg or foot impedance, thereby rejecting any imaginary, capacitivecomponents which may arise from parasitic elements associated with thefoot to electrode contacts.

Once demodulated, the signal is band-pass filtered (0.4-80 Hz) with aband-pass filter circuit 330 before being amplified with a gain of 100with a non-inverting amplifier circuit 335 (e.g., using an LT1058operational amplifier from Linear Technology Inc.). The amplified signalis further amplified by 10 and low-pass filtered (cut-off at 20 Hz)using a low-pass filter circuit 340 such as 2-pole Sallen-Key filterstage with gain. The signal is then ready for digitization and furtherprocessing. In certain embodiments, the signal from the demodulatorcircuit 325 can be passed through an additional low-pass filter circuit345 to determine body or foot impedance.

In certain embodiments, the generation of the excitation voltage signal,of appropriate frequency and amplitude, is carried out by amicrocontroller, such as an MSP430 (Texas Instruments, Inc.) or aPIC18Fxx series (Microchip Technology, Inc.). The voltage waveform canbe generated using the on-chip timers and digital input/outputs or pulsewidth modulation (PWM) peripherals, and scaled down to the appropriatevoltage through fixed resistive dividers, active attenuators/amplifiersusing on-chip or off-chip operational amplifiers, as well asprogrammable gain amplifiers or programmable resistors. In certainembodiments, the generation of the excitation frequency signal can beaccomplished by an independent quartz crystal oscillator whose output isfrequency divided down by a series of toggle flip-flops (such as anECS-100AC from ECS International, Inc., and a CD4024 from TexasInstruments, Inc.). In certain embodiments, the generation of the waveshape and frequency can be accomplished by a direct digital synthesis(DDS) integrated circuit (such as an AD9838 from Analog Devices, Inc.).In certain embodiments, the generation of the wave shape (either sine orsquare) and frequency can be accomplished by a voltage-controlledoscillator (VCO) which is controlled by a digital microcontroller, orwhich is part of a phase-locked loop (PLL) frequency control circuit.Alternatively, the waveforms and frequencies can be directly generatedby on- or off-chip digital-to-analog converters (DACs).

In certain embodiments, the shape of the excitation is not square, butsinusoidal. Such configuration would reduce the requirements onbandwidth and slew rate for the current source and instrumentationamplifier. Harmonics, potentially leading to higher electromagneticinterference (EMI), would also be reduced. Such excitation may alsoreduce electronics noise on the circuit itself. Lastly, the lack ofharmonics from sine wave excitation may provide a more flexibleselection of frequencies in a multi-frequency impedance system, asexcitation waveforms have fewer opportunities to interfere between eachother. Due to the concentration of energy in the fundamental frequency,sine wave excitation could also be more power-efficient. In certainembodiments, the shape of the excitation is not square, but trapezoidal.Alternatively, raised cosine pulses (RCPs) could be used as theexcitation wave shape, providing an intermediate between sine and squarewaves. RCPs could provide higher excitation energy content for a givenamplitude, but with greatly reduced higher harmonics.

To further reduce potential electromagnetic interference (EMI), otherstrategies may be used, such as by dithering the square wave signal(i.e., introducing jitter in the edges following a fixed or randompattern) which leads to so-called spread spectrum signals, in which theenergy is not localized at one specific frequency (or a set ofharmonics), but rather distributed around a frequency (or a set ofharmonics). Because of the synchronous demodulation scheme,phase-to-phase variability introduced by spread-spectrum techniques willnot affect the impedance measurement. Such a spread-spectrum signal canbe generated by, but not limited to, specialized circuits (e.g., MaximMAX31C80, SiTime SiT9001), or generic microcontrollers (see ApplicationReport SLAA291, Texas Instruments, Inc.). These spread-spectrumtechniques can be combined with clock dividers to generate lowerfrequencies as well.

As may be clear to one skilled in the art, these methods of simultaneousmeasurement of impedance in the leg and foot can be used for standardBody Impedance Analysis (BIA), aiming at extracting the relative contentof total water, free-water, fat mass and other body compositionmeasures. Impedance measurements for BIA are typically done atfrequencies ranging from kilohertz up to several megahertz. Themulti-frequency synchronous detection measurement methods describedabove can readily be used for such BIA, provided that low-pass filtering(345, FIGS. 3a and 3b ) instead of band-pass filtering (330, FIGS. 3aand 3b ) is performed following the demodulation. In certainembodiments, a separate demodulator channel may be driven by thequadrature phase of the excitation signal to allow the imaginarycomponent of the body impedance to be extracted in addition to the realcomponent. A more accurate BIA can be achieved by measuring both thereal and imaginary components of the impedance. This multi-frequencytechnique can be combined with traditional sequential measurements usedfor BIA, in which the impedance is measured at several frequenciessequentially. These measurements are repeated in several body segmentsfor segmental BIAs, using a switch matrix to drive the current into thedesired body segments.

While FIG. 2a shows a circuit and electrode configuration suitable tomeasure two different segments (legs and one foot), this approach is notreadily extendable to more segments due to the shared current returnelectrode (ground). To overcome this limitation, and providesimultaneous measurements in both feet, the system can be augmented withanalog switches to provide time-multiplexing of the impedancemeasurements in the different segments. This multiplexing can be aone-time sequencing (each segment is measured once), or interleaved at ahigh-enough frequency that the signal can be simultaneously measured oneach segment. The minimum multiplexing rate for proper reconstruction istwice the bandwidth of the measured signal, based on signal processingtheory (the Nyquist rate), which equals to about 100 Hz for theimpedance signal considered here. The rate must also allow for thesignal path to settle in between switching, which usually limits themaximum multiplexing rate. Referring to FIG. 14 a, one cycle might startthe measurement of the leg impedance and left foot impedances (similarlyto previously described, sharing a common return electrode), but thenfollow with a measurement of the right foot after reconfiguring theswitches. For specific information regarding typical switchconfigurations, reference to U.S. patent application Ser. No. 14/338,266filed on Oct. 7, 2015, which is fully incorporated for its specific andgeneral teaching of switch configurations.

Since right and left feet are measured sequentially, one should notethat a unique current source (at the same frequency) may be used tomeasure both, providing that the current source is not connected to thetwo feet simultaneously through the switches, in which case the currentwould be divided between two paths. One should also note that afully-sequential measurement, using a single current source (at a singlefrequency) successively connected to the three different injectionelectrodes, could be used as well, with the proper switch configurationsequence (no splitting of current path).

In certain embodiments, the measurement of various body segments (e.g.,the legs, right foot and left foot) is achieved simultaneously due to asmany floating current sources as segments to be measured, running atseparate frequencies so they can individually be demodulated. Suchconfiguration is exemplified in FIG. 14b for three segments (legs, rightand left feet). Such configuration provides true simultaneousmeasurements without the added complexity oftime-multiplexing/demultiplexing, and associated switching circuitry. Anexample of such a floating current source is found in Plickett, et al.,Physiological Measurement, 32 (2011). Another approach to floatingcurrent sources is the use of transformer-coupled current sources (asdepicted in FIG. 14c ). Using transformers to inject current into theelectrodes enables the use of simpler, grounded-load current sources onthe primary, while the electrodes are connected to the secondary. Thetransformer turns ratio can typically be 1:1, and since frequencies ofinterest for impedance measurement are typically in the 10-1000 kHz(occasionally 1 kHz for BIA), relatively small pulse transformers can beused. In order to limit the common mode voltage of the body, one of theelectrodes in contact with the foot can be grounded.

While certain embodiments presented in the above specification have usedcurrent sources for excitation, the excitation can also be performed bya voltage source, where the resulting injection current is monitored bya current sense circuit so that impedance can still be derived by theratio of the sensed voltage (on the sense electrodes) over the sensedcurrent (injected in the excitation electrodes). It should be noted thatbroadband spectroscopy methods could also be used for measuringimpedances at several frequencies. Combined with time-multiplexing andcurrent switching described above, multi-segment broadband spectroscopycan be achieved.

Various aspects of the present disclosure are directed toward robusttiming extraction of the blood pressure pulse in the foot which isachieved by means of a two-step processing. In a first step, the usuallyhigh-SNR Leg IPG is used to derive a reference (trigger) timing for eachheart pulse. In a second step, a specific timing in the lower-SNR FootIPG is extracted by detecting its associated feature within a restrictedwindow of time around the timing of the Leg IPG.

Consistent with yet further embodiments of the present disclosure, FIG.3c depicts an example block diagram of circuitry for operating corecircuits and modules, including, for example, the operation of the CPUas in FIG. 1a with the related more specific circuit blocks/modules inFIGS. 3A-3B. As shown in the center of FIG. 3 c, the computer circuit370 is shown with other previously-mentioned circuitry in a generalizedmanner without showing some of the detailed circuitry (e.g.,amplification and current injection/sensing (372)). The computer circuit370 can be used as a control circuit with an internal memory circuit (oras integrated with the memory circuit for the user profile memory 146Aof FIG. 1a ) for causing, processing and/or receiving sensed inputsignals as at block 372. As discussed, these sensed signals can beresponsive to injection current and/or these signals can be sensed byless complex grid-based sense circuitry surrounding the platform as isconvention in capacitive touch-screen surfaces which, in certainembodiments, the platform includes.

As noted, the memory circuit can be used not only for the user profilememory, but also as to provide configuration and/or program code and/orother data such as user-specific data from another authorized sourcesuch as from a user monitoring his/her logged data and/or profile from aremote desk-top. The remote device or desk-top can communicate with andaccess such data via a wireless communication circuit 376. For example,the wireless communication circuit 376 provides an interface between anapp on the user's cellular telephone/tablet and the apparatus, wherefromthe IPhone is the output/input interface for the platform (scale)apparatus including, for example, an output display, speaker and/ormicrophone, and vibration circuitry; each of these I/O aspects andcomponents being discussed herein in connection with other exampleembodiments.

A camera 378 and image encoder circuit 380 (with compression and relatedfeatures) can also be incorporated as an option. As discussed above, theweighing scale components, as in block 382, are also optionally includedin the housing which encloses and/or surrounds the platform.

For long-lasting battery life in the platform apparatus (batteries notshown), at least the CPU 370, the wireless communication circuit 376,and other current draining circuits are inactive unless and untilactivated in response to the intrusion/sense circuitry 388. As shown,one specific implementation employs a Conexant chip (e.g., CX93510) toassist in the low-power operation. This type of circuitry is designedfor motion sensors configured with a camera for visual verification andimage and video monitoring applications (such as by supporting JPEG andMJPEG image compression and processing for both color and black andwhite images). When combined with an external CMOS sensor, the chipretrieves and stores compressed JPEG and audio data in an on-chip memorycircuit (e.g., 256 KB/128 KB frame buffer) to alleviate the necessity ofexternal memory. The chip uses a simple register set via themicroprocessor interface and allows for wide flexibility in terms ofcompatible operation with another microprocessor.

In one specific embodiment, a method of using the platform with theplurality of electrodes are concurrently contacting a limb of the user,includes operating such to automatically obtain measurement signals fromthe plurality of electrodes. As noted above, these measurement signalsmight initially be through less complex (e.g., capacitive grid-type)sense circuitry. Before or while obtaining a plurality of measurementsignals by operating the circuitry, the signal-sense circuitry 388 isused to sense wireless-signals indicative of the user approaching theplatform and, in response, causing the CPU circuitry 370 to transitionfrom a reduced power-consumption mode of operation and at least onehigher power-consumption mode of operation. After the circuitry isoperating in the higher power-consumption mode of operation, the CPUaccesses the user-corresponding data stored in the memory circuit andcauses a plurality of impedance-measurement signals to be obtained byusing the plurality of electrodes while they are contacting the user viathe platform; therefrom, the CPU generates signals corresponding tocardiovascular timings of the user.

The signal-sense circuit can be employed as a passive infrared detectorand with the CPU programmed (as a separate module) to evaluate whetherradiation from the passive infrared detector is indicative of a human.For example, sensed levels of radiation that corresponds to a livebeing, such as a dog, that is less than a three-foot height, and/or hasnot moved for more than a couple seconds, can be assessed as being anon-human.

Accordingly, as the user is recognized as being human, the CPU isactivated and begins to attempt the discernment process of which usermight be approaching. This is performed by the CPU accessing theuser-corresponding data stored in the memory circuit (the user profilememory). If the user is recognized based on parameters such as discussedabove (e.g., time of morning, speed of approach, etc.), the CPU can alsoselect one of a plurality of different types of user-discerniblevisual/audible/tactile information and for presenting the discerned userwith visual/audible/tactile information that was retrieved from thememory as being specific to the user. For example, user-selectedvisual/audible data can be outputted for the user. Also, responsive tothe motion detection indication, the camera can be activated to captureat least one image of the user while the user is approaching theplatform (and/or while the user is on the platform to log confirmationof the same user with the measured impedance information). As shown inblock 374 of FIG. 3 c, where a speaker is also integrated with the CPU,the user can simply command the platform apparatus to start the processand activation proceeds. As previously discussed, the scale can includevoice input/output circuitry to receive the user commands via voicecommands.

In another method, the circuitry of FIG. 3c is used with the electrodesbeing interleaved and engaging the user, as a combination weighing scale(via block 382) and a physiologic user-specific impedance-measurementdevice. By using the impedance-measurement signals and obtaining atleast two impedance-measurement signals between one foot of the user andanother location of the user, the interleaved electrodes assist the CPUin providing measurement results that indicate one or more of thefollowing user-specific attributes as being indicative or common to theuser: foot impedance, foot length, and type of arch, and wherein one ormore of the user-specific attributes are accessed in the memory circuitand identified as being specific to the user. This information can belater retrieved by the user, medical and/or security personnel,according to a data-access authorization protocol as might beestablished upon initial configuration for the user.

FIG. 3d shows an exemplary block diagram depicting the circuitry forinterpreting signals received from electrodes (e.g., 372 of FIG. 3c ),and/or CPU 370 of FIG. 3 c. The input electrodes 375 transmit electricalsignals through the patient's body (depending on the desired biometricand physiological test to be conducted) and output electrodes 380receive the modified signal as affected by a user's electrical impedance385. Once received by the output electrodes 380, the modified signal isprocessed by processor circuitry 370 based on the selected test. Signalprocessing conducted by the processor circuitry 370 is discussed in moredetail above (with regard to FIGS. 3a-b ). In certain embodiments of thepresent disclosure, the circuitry within 370 is provided by TexasInstruments part #AFE4300.

FIG. 4 shows an example block diagram depicting signal processing stepsto obtain fiducial references from the individual Leg IPG “beats,” whichare subsequently used to obtain fiducials in the Foot IPG, consistentwith various aspects of the present disclosure. In the first step, asshown in block 400, the Leg IP and the Foot IPG are simultaneouslymeasured. As shown at 405, the Leg IPG is low-pass filtered at 20 Hzwith an 8-pole Butterworth filter, and inverted so that pulses have anupward peak. The location of the pulses is then determined by taking thederivative of this signal, integrating over a 100 ms moving window,zeroing the negative values, removing the large artifacts by zeroingvalues beyond 15× the median of the signal, zeroing the values below athreshold defined by the mean of the signal, and then searching forlocal maxima. Local maxima closer than a defined refractory period of300 ms to the preceding ones are dismissed. The result is a time seriesof pulse reference timings.

As is shown in 410, the foot IPG is low-pass filtered at 25 Hz with an8-pole Butterworth filter and inverted (so that pulses have an upwardpeak). Segments starting from the timings extracted (415) from the LegIPG (reference timings) and extending to 80% of the previous pulseinterval, but no longer than one second, are defined in the Foot IPG.This defines the time windows where the Foot IPG is expected to occur,avoiding misdetection outside of these windows. In each segment, thederivative of the signal is computed, and the point of maximum positivederivative (maximum acceleration) is extracted. The foot of the IPGsignal is then computed using an intersecting tangent method, where thefiducial (420) is defined by the intersection between a first tangent tothe IPG at the point of maximum positive derivative and a second tangentto the minimum of the IPG on the left of the maximum positive derivativewithin the segment.

The time series resulting from this two-step extraction is used withanother signal to facilitate further processing. These timings are usedas reference timings to improve the SNR of BCG signals to extractintervals between a timing of the BCG (typically the I-wave) and theFoot IPG for the purpose of computing the PWV, as previously disclosedin U.S. 2013/0310700 (Wiard). In certain embodiments, the timings of theLeg IPG are used as reference timings to improve the SNR of BCG signals,and the foot IPG timings are used to extract intervals between timingfiducials of the improved BCG (typically the I-wave) and the Foot IPGfor the purpose of computing the PTT and the (PWV).

In certain embodiments, the processing steps include an individual pulseSNR computation after individual timings are extracted, either in LegIPG or Foot IPG. Following the computation of the SNRs, pulses with aSNR below a threshold value are eliminated from the time series, toprevent propagating noise. The individual SNRs may be computed in avariety of methods known to one skilled in the art. For instance, anestimated pulse can be computed by ensemble averaging segments of signalaround the pulse reference timing. The noise associated with each pulseis defined as the difference between the pulse and the estimated pulse.The SNR is the ratio of the root-mean-square (RMS) value of theestimated pulse over the RMS value of the noise for that pulse.

In certain embodiments, the time interval between the Leg IPG pulses,and the Foot IPG pulses, also detected by the above-mentioned methods,is extracted. The Leg IPG measuring a pulse occurring earlier in thelegs compared to the pulse from the Foot IPG, the interval between thesetwo is related to the propagation speed in the lower body, i.e., theperipheral vasculature. This provides complementary information to theinterval extracted between the BCG and the Foot IPG for instance, and isused to decouple central versus peripheral vascular properties. It isalso complementary to information derived from timings between the BCGand the Leg ICG.

FIG. 5 shows an example flowchart depicting signal processing to segmentindividual Foot IPG “beats” to produce an averaged IPG waveform ofimproved SNR, which is subsequently used to determine the fiducial ofthe averaged Foot IPG, consistent with various aspects of the presentdisclosure. Similar to the method shown in FIG. 4, the Leg IP and theFoot IPG are simultaneously measured (500), the Leg IPG is low-passfiltered (505), the foot IPG is low-pass filtered (510), and segmentsstarting from the timings extracted (515) from the Leg IPG (referencetimings). The segments of the Foot IPG extracted based on the Leg IPGtimings are ensemble-averaged (520) to produce a higher SNR Foot IPGpulse. From this ensemble-averaged signal, the start of the pulse isextracted using the same intersecting tangent approach as describedearlier. This approach enables the extraction of accurate timings in theFoot IPG even if the impedance signal is dominated by noise, as shown inFIG. 7 b. These timings are used together with timings extracted fromthe BCG for the purpose of computing the PTT and (PWV). Timings derivedfrom ensemble-averaged waveforms and individual waveforms can also beboth extracted, for the purpose of comparison, averaging anderror-detection.

Specific timings extracted from the IPG pulses (from either leg or foot)are related (but not limited) to the peak of the pulse, the minimumpreceding the peak, or the maximum second derivative (maximum rate ofacceleration) preceding the point of maximum derivative. An IPG pulseand the extraction of a fiducial (525) in the IPG can be performed byother signal processing methods, including (but not limited to) templatematching, cross-correlation, wavelet-decomposition, or short windowFourier transform.

FIG. 6a shows examples of the Leg IPG signal with fiducials (plot 600);the segmented Leg IPG into beats (plot 605); and the ensemble-averagedLeg IPG beat with fiducials and calculated SNR (plot 610), for anexemplary high-quality recording, consistent with various aspects of thepresent disclosure.

FIG. 6b shows examples of the Foot IPG signal with fiducials derivedfrom the Leg IPG fiducials (plot 600); the segmented Foot IPG into beats(plot 605); and the ensemble-averaged Foot IPG beat with fiducials andcalculated SNR (plot 610), for an exemplary high-quality recording,consistent with various aspects of the present disclosure.

FIG. 7a shows examples of the Leg IPG signal with fiducials (plot 700);the segmented Leg IPG into beats (plot 705); and the ensemble averagedLeg IPG beat with fiducials and calculated SNR (plot 710), for anexemplary low-quality recording, consistent with various aspects of thepresent disclosure.

FIG. 7b shows examples of the Foot IPG signal with fiducials derivedfrom the Leg IPG fiducials (plot 700); the segmented Foot IPG into beats(plot 705); and the ensemble-averaged Foot IPG beat with fiducials andcalculated SNR (plot 710), for an exemplary low-quality recording,consistent with aspects of the present disclosure.

FIG. 8 shows an example correlation plot 800 for the reliability inobtaining the low SNR Foot IPG pulse for a 30-second recording, usingthe first impedance signal as the trigger pulse, from a study including61 test subjects with various heart rates, consistent with variousaspects of the present disclosure.

In certain embodiments, a dual-Foot IPG is measured, allowing thedetection of blood pressure pulses in both feet. Such information can beused for diagnostic of peripheral arterial diseases (PAD) by comparingthe relative PATs in both feet to look for asymmetries. It can alsoincrease the robustness of the measurement by allowing one foot to havepoor contact with electrodes (or no contact at all). SNR measurementscan be used to assess the quality of the signal in each foot, and toselect the best one for downstream analysis. Timings extracted from eachfoot can be compared and set to flag potentially inaccurate PWVmeasurements due to arterial peripheral disease, in the event thesetimings are different by more than a threshold. Alternatively, timingsfrom both feet are pooled to increase the overall SNR if theirdifference is below the threshold.

In certain embodiments, the disclosure is used to measure a PWV, wherethe IPG is augmented by the addition of BCG sensing into the weighingscale to determine characteristic fiducials between the BCG and Leg IPGtrigger, or the BCG and Foot IPG. The BCG sensors are comprisedtypically of the same strain gage set used to determine the bodyweightof the user. The load cells are typically wired into a bridgeconfiguration to create a sensitive resistance change with smalldisplacements due to the ejection of the blood into the aorta, where thecirculatory or cardiovascular force produce movements within the body onthe nominal order of 1-3 Newtons. BCG forces can be greater than or lessthan the nominal range in cases such as high or low cardiac output.

FIGS. 9a-b show example configurations to obtain the PTT, using thefirst IPG as the triggering pulse for the Foot IPG and BCG, consistentwith various aspects of the present disclosure. The I-wave of the BCG900 normally depicts the headward force due to cardiac ejection of bloodinto the ascending aorta which is used as a timing fiducial indicativeof the pressure pulse initiation of the user's proximal aorta relativeto the user's heart. The J-wave is indicative of timings in the systolephase and also incorporates information related to the strength ofcardiac ejection and the ejection duration. The K-Wave provides systolicand vascular information of the user's aorta. The characteristic timingsof these and other BCG waves are used as fiducials that can be relatedto fiducials of the IPG signals of the present disclosure.

FIG. 10 shows nomenclature and relationships of various cardiovasculartimings, consistent with various aspects of the present disclosure.

FIG. 11 shows an example graph 1100 of PTT correlations for twodetection methods (white dots) Foot IPG only, and (black dots) Dual-IPGmethod; and FIG. 12 shows an example graph 1200 of PWV obtained from thepresent disclosure compared to the ages of 61 human test subjects,consistent with various aspects of the present disclosure.

FIG. 13 shows an example of a scale 1300 with integrated foot electrodes1305 to inject and sense current from one foot to another foot, andwithin one foot.

FIG. 14a-c shows various examples of a scale 1400 with interleaved footelectrodes 1405 to inject/sense current from one foot to another foot,and measure Foot IPG signals in both feet.

FIGS. 15a-d shows an example breakdown of a scale 1500 with interleavedfoot electrodes 1505 to inject and sense current from one foot toanother foot, and within one foot.

FIG. 16 shows an example block diagram of circuit-based building blocks,consistent with various aspects of the present disclosure. The variouscircuit-based building blocks shown in FIG. 16 can be implemented inconnection with the various aspects discussed herein. In the exampleshown, the block diagram includes foot electrodes 1600 that can collectthe IPG signals. Further, the block diagram includes strain gauges 1605,and an LED/photosensor 1610. The foot electrodes 1600 is configured witha leg impedance measurement circuit 1615, a foot impedance measurementcircuit 1620, and an optional second foot impedance measurement circuit1625. The leg impedance measurement circuit 1615, the foot impedancemeasurement circuit 1620, and the optional second foot impedancemeasurement circuit 1625 report the measurements collected to aprocessor circuitry 1645.

The processor circuitry 1645 collects data from a weight measurementcircuit 1630 and an optional balance measurement circuit 1635 that areconfigured with the strain gauges 1605. Further, an optionalphotoplethysmogram (PPG) measurement circuit 1640, which collects datafrom the LED/photosensor 1610, provides data to the processor circuitry1645.

The processor circuitry 1645 is powered via a power circuit 1650.Further, the processor circuitry 1645 collects user input data from auser interface 1655 (e.g., iPad®, smart phone and/or other remote userhandy/CPU with a touch screen and/or buttons). The datacollected/measured by the processor circuitry 1645 is shown to the uservia a display 1660. Additionally, the data collected/measured by theprocessor circuitry 1645 can be stored in a memory circuit 1680.Further, the processor circuitry 1645 can optionally control a hapticfeedback circuit 1665, a speaker or buzzer 1670, a wired/wirelessinterface 1675, and an auxiliary sensor 1685.

FIG. 17 shows an example flow diagram, consistent with various aspectsof the present disclosure. At block 1700, a PWV length is entered. Atblock 1705, a user's weight, balance, leg, and foot impedance aremeasured. At 1710, the integrity of signals is checked (e.g., SNR). Ifthe signal integrity check is not met, the user's weight, balance, leg,and foot impedance are measured again (block 1705), if the signalsintegrity check is met, the leg impedance pulse timings are extracted(as is shown at block 1715). At block 1720, foot impedance and pulsetimings are extracted, and at block 1725, BCG timings are extracted. Atblock 1730, a timings quality check is performed. If the timings qualitycheck is not validated, the user's weight, balance, leg and footimpedance are again measured (block 1705). If the timings quality checkis validated, the PWV is calculated (as is shown at block 1735). Atblock 1740, the PWV is displayed to the user.

FIG. 18 shows an example scale 1800 communicatively coupled to awireless device, consistent with various aspects of the presentdisclosure. As described herein, a display 1805 displays the variousaspects measured by the scale 1800. The scale can also wirelesslybroadcast the measurements to a wireless device 1810. The wirelessdevice 1810, in various embodiments, is implemented as an iPad®, smartphone or other CPU to provide input data for configuring and operatingthe scale.

As an alternative or complementary user interface, the scale includes aFUI which can be enabled/implementable by one or more foot-basedbiometrics (for example, with the user being correlated topreviously-entered user weight, and/or foot size/shape). The userfoot-based biometric, in some embodiments, is implemented by the usermanually entering data (e.g., a password) on the upper surface ordisplay area of the scale. In implementations in which the scale isconfigured with a haptic, capacitive or flexible pressure-sensing uppersurface, the (upper surface/tapping) touching from or by the user issensed in the region of the surface and processed according toconventional X-Y grid Signal processing in the logic circuitry/CPU thatis within the scale. By using one or more of the accelerometers locatedwithin the scale at its corners, such user data entry is sensed by eachsuch accelerometer so long as the user's toe, heel or foot pressureassociated with each tap provides sufficient force. Although the presentdiscussion refers to a FUI, embodiments are not so limited. Variousembodiments include internal or external GUIs that are in communicationwith the scale and used to obtain a biometric and that can be in placeof the FUI and/or in combination with a FUI. For example, a user devicehaving a GUI, such as tablet, is in communication with the scale via awired or wireless connection. The user device obtains a biometric, sucha finger print, and communicates the biometric to the scale. In aspecific example, when the user stands on the platform of the scale, andthe scale detects touching of the toe, the scale can reject the toetouch (or tap) as a foot signal (e.g., similar to wrist rejection forcapacitive tablets with stylus).

In various embodiments, the above discussed user-interface is used withother features described herein for the purpose of storing and securinguser data that is sensitive such as: the configuration data input by theuser, the biometric and/or passwords entered by the user, and theuser-specific health related data which might include less sensitivedata (e.g., the user's weight) and more sensitive data (e.g., the user'sscale obtains cardiograms and other data generated by or provided to thescale and associated with the user's symptoms and/or diagnoses). Forsuch user data, the above described biometrics are used as directed bythe user for indicating and defining protocol to permit such data to beexported from the scale to other remote devices indoor locations. Inmore specific embodiments, the scale operates in different modes of datasecurity including, for example: a default mode in which the user's bodymass and/or weight is displayed regardless of any biometric which wouldassociate with the specific user standing on the scale; another mode inwhich complicated data (or data reviewed infrequently) is only exportedfrom the scale under specific manual commands provided to the scaleunder specific protocols; and another mode or modes in which theuser-specific data that is collected from the scale is processed andaccessed based on the type of data. Such data categories includecategories of different level of importance and/or sensitivities such asthe above-discussed high and low level data and other data that might bevery specific to a symptom and/or degrees of likelihood for diagnoses.Optionally, the CPU in the scale is also configured to provideencryption of various levels of the user's sensitive data.

For example, in accordance with various embodiments, the above-describedFUI is used to provide portions of the user data, clinical indications(e.g., scale-obtained physiological data) and/or additional healthinformation to the user. In some embodiments, the scale includes adisplay configuration filter (e.g., circuitry and/or computer readablemedium) configured to discern the data to display to the user anddisplay portion. The display configuration filter discerns whichportions of the user data, clinical indications and/or additional healthinformation to display to the user on the FUI based on various userdemographic information (e.g., age, gender, height, diagnosis) and theamount of data. For example, the clinical indication may include anamount of data that if all the data is displayed on the FUI, the data isdifficult for a person to read and/or uses multiple display screens.

The display configuration filter discerns portions of the data todisplay using the scale user interface, such as synopsis of the clinicalindication (or user data or additional health information) and anindication that additional data is displayed on another user device, andother portions to display on the other user device. The other userdevice is selected by the scale (e.g., the filter) based on variouscommunications settings. The communication settings include settingssuch as user settings (e.g., the user identifying user devices to outputdata to), scale-based biometrics (e.g., user configures scale, ordefault settings, to output data to user devices in response toidentifying scale-based biometrics), and/or proximity of the user device(e.g., the scale outputs data to the closest user device among aplurality of user devices and/or in response to the user device beingwithin a threshold distance from the scale), among other settings. Forexample, the scale determines which portions of the used data, clinicalindication, and/or additional health information to output and outputsthe remaining portion of the user data, clinical indication, and/oradditional health information to a particular user device based on usersettings/communication authorization (e.g., what user devices areauthorized by the user to receive particular user data from the scale),and proximity of the user device to the scale. The determination ofwhich portions to output is based on what type of data is beingdisplayed, how much data is available, and the various user demographicinformation (e.g., an eighteen year old is able to see better than afifty year old).

For example, in some specific embodiments, the scale operates indifferent modes of data security and communication. The different modesof data security and communication are enabled in response to biometricsidentified by the user and using the FUI. In some embodiments, the scaleis used by multiple users and/or the scale operates in different modesof data security and communication in response to identifying the userand based on biometrics. The different modes of data security andcommunication include, for example: a first mode (e.g., default mode) inwhich the user's body mass and/or weight is displayed regardless of anybiometric which would associate with the specific user standing on thescale and no data is communicated to external circuitry; a second modein which complicated/more-sensitive data (or data reviewed infrequently)is only exported from the scale under specific manual commands providedto the scale under specific protocols and in response to a biometric;and third mode or modes in which the user-specific data that iscollected from the scale is processed and accessed based on the type ofdata and in response to a biometric. Such data categories includecategories of different levels of importance and/or sensitivities suchas the above-discussed high and low level data and other data that mightbe very specific to a symptom and/or degrees of likelihood fordiagnoses. Optionally, the CPU in the scale is also configured toprovide encryption of various levels of the user's sensitive data.

In some embodiments, the different modes of data security andcommunication are enabled in response to recognizing the user standingon the scale using a biometric and operating in a particular mode ofdata security and communication based on user preferences and/orservices activated. For example, the different modes of operationinclude the default mode (as discussed above) in which certain data(e.g., categories of interest, categories of user data, or historicaluser data) is not communicated from the scale to external circuitry, afirst communication mode in which data is communicated to externalcircuitry as identified in a user profile, a second or morecommunication modes in which data is communicated to a differentexternal circuitry for further processing. The different communicationmodes are enabled based on biometrics identified from the user and usersettings in a user profile corresponding with each user.

In a specific embodiment, a first user of the scale may not beidentified and/or have a user profile set up. In response to the firstuser standing on the scale, the scale operates in a default mode. Duringthe default mode, the scale displays the user's body mass and/or weighton the user display and does not output user data. The scale, in variousembodiments, displays a prompt on the FUI indicating the first user canestablish a user profile. In response to the user selecting the prompt,the scale, using the user interface, enters an initialization mode.During the initialization mode, the scale asks the users variousquestions, such as identification of external circuitry to send data to,identification information of the first user, and/or demographics of theuser. The user provides inputs using the FUI to establish variouscommunication modes associated with the user profile and scale-basedbiometrics to enable the one or more communication modes. The scalefurther collects user data to identify the scale-based biometrics andstores an indication of the scale-based biometric in the user profilesuch that during subsequent measurements, the scale recognizes the userand authorizes a particular communication mode. Alternatively, the userprovides inputs using another device that is external to the scale andin communication with the scale (e.g., a cellphone).

A second user of the scale has a user profile set up that indicates theuser would like data communicated to a computing device of the user.When the second user stands on the scale, the scale recognizes thesecond user based on a biometric and operates in a first communicationmode. During the first communication mode, the scale outputs at least aportion of the user data to an identified external circuitry. Forexample, the first communication mode allows the user to upload datafrom the scale to a user identified external circuitry (e.g., thecomputing device of the user). The information may include additionalhealth information and/or user information that has low-usersensitivity. In the first communication mode, the scale performs theprocessing of the raw sensor data and/or the external circuitry can. Forexample, the scale sends the raw sensor data and/or additional healthinformation to a user device of the user. The computing device may notprovide access to the raw sensor data to the user and/or can send theraw sensor data to another external circuitry for further processing inresponse to a user input. For example, the computing device can ask theuser if the user would like additional health information and/orregulated health information as a service. In response to receiving anindication the user would like the additional health information and/orregulated health information, the computing device outputs the rawsensor data and/or non-regulated health information to another externalcircuitry for processing, providing to a physician for review, andcontrolling access, as discussed above.

In one or more additional communication modes, the scale outputs rawsensor data to an external circuitry for further processing. Forexample, during a second communication mode and a third communication,the scale sends the raw sensor data and/or other data to externalcircuitry for processing, such as to a user device for correlation andprocessing. Using the above-provided example, a third user of the scalehas a user profile set up that indicates the third user would likescale-obtained data to be communicated to a user device for furtherprocessing, such as to correlate the cardio-data sets and/or furtherprocess the correlated data sets. When the third user stands on thescale, the scale recognizes the third user based on one or morebiometrics and operates in a second communication mode. During thesecond communication mode, the scale outputs raw sensor data to the userdevice. The user device correlates the raw sensor data from the scalewith cardio-physiological data from the remote user-physiologicaldevice, determines at least one physiological parameter of the user,and, optionally, derives additional health information. In someembodiments, the user device outputs data, such as the physiologicalparameter or additional health information to the scale. The scale, insome embodiments, displays a synopsis of the additional healthinformation and outputs a full version of the additional healthinformation to another user device for display (such as, using thefilter described above) and/or an indication that additional healthinformation can be accessed.

A fourth user of the scale has a user profile set up that indicates thefourth user has enabled a service to access regulated healthinformation. When the fourth user stands on the scale, the scalerecognizes the user based on one or more biometrics and operates in afourth communication mode. In the fourth communication mode, the scaleoutputs raw sensor data to the external circuitry, and the externalcircuitry processes the raw sensor data and controls access to the data.For example, the external circuitry may not allow access to theregulated health information until a physician reviews the information.In some embodiments, the external circuitry outputs data to the scale,in response to physician review. For example, the output data caninclude the regulated health information and/or an indication thatregulated health information is ready for review. The external circuitrymay be accessed by the user, using the scale and/or another user device.In some embodiments, using the FUI of the scale, the scale displays theregulated health information to the user. The scale, in someembodiments, displays a synopsis of the regulated health information(e.g., clinical indication) and outputs the full version of regulatedhealth information to another user device for display (such as, usingthe filter described above) and/or an indication that the regulatedhealth information can be accessed to the scale to display. In variousembodiments, if the scale is unable to identify a particular (highsecurity) biometric that enables the fourth communication mode, thescale may operate in a different communication mode and may stillrecognize the user. For example, the scale may operate in a defaultcommunication mode in which the user data collected by the scale isstored in a user profile corresponding to the fourth user and on thescale. In some related embodiments, the user data is output to theexternal circuitry at a different time.

Although the present embodiments illustrates a number of security andcommunication modes, embodiments in accordance with the presentdisclosure can include additional or fewer modes. Furthermore,embodiments are not limited to different modes based on different users.For example, a single user may enable different communication modes inresponse to particular biometrics of the user identified and/or based onuser settings in a user profile.

In various embodiments, the scale defines a user data table that definestypes of user data and sensitivity values of each type of user data. Inspecific embodiments, the FUI displays the user data table. In otherspecific embodiments a user interface of a smartphone, tablet, and/orother computing device displays the user data table. For example, awired or wireless tablet is used, in some embodiments, to display theuser data table. The sensitivity values of each type of user data, insome embodiments, define in which communication mode(s) the data type iscommunicated and/or which biometric is used to enable communication ofthe data type. In some embodiments, a default or pre-set user data tableis displayed and the user revises the user data table using the FUI. Therevisions are in response to user inputs using the user's foot and/orcontacting or moving relative to the FUI. Although the embodiments arenot so limited, the above (and below) described control and display isprovided using a wireless or wired tablet or other computing device as auser interface. The output to the wireless or wired tablet, as well asadditional external circuitry, is enabled using biometrics. For example,the user is encouraged, in particular embodiments, to configure thescale with various biometrics. The biometric include scale-basedbiometrics and biometrics from the tablet or other user computingdevice. The biometric, in some embodiments, used to enable output ofdata to the tablet and/or other external circuitry includes a higherintegrity biometric (e.g., higher likelihood of identifying the useraccurately) than a biometric used to identify the user and stored dataon the scale.

An example user data table is illustrated below:

User-data Type Body Mass Index, User- Physician- Scale-stored Weight,user Specific Provided suggestions local specific Adver- Diagnosis/(symptoms & news news tisements Reports diagnosis) Sensitivity 1 3 5 109 (10 = highest, 1 = lowest)The above-displayed table is for illustrative purposes and embodimentsin accordance with the present disclosure can include additionaluser-data types than illustrated, such as cardiogram characteristics,clinical indications, physiological parameters, user goals, demographicinformation, etc. In various embodiments, the user data table includesadditional rows than illustrated. The rows, in specific embodiments,include different data input sources and/or sub-data types (as discussedbelow). Data input sources include source of the data, such as physicianprovided, input from the Internet, user provided, from the externalcircuitry. The different data from the data input sources, in someembodiments, is used alone or in combination.

In accordance with various embodiments, the scale uses a cardiogram (onits own or in addition to weight, BCG, ECG, ECG-to-BCG timings, and/orvarious combinations) of the user and/or other scale-obtained biometricsto differentiate between two or more users. The scale-obtained dataincludes health data that is sensitive to the user, such thatunintentional disclosure of scale-obtained data is not desired.Differentiating between the two or more users and automaticallycommunicating (e.g., without further user input) user data responsive toscale-obtained biometrics, in various embodiments, provides auser-friendly and simple way to communicate data from a scale whileavoiding and/or mitigating unintentional (and/or without user consent)communication. For example, the scale, such as during an initializationmode for each of the two or more users and as previously discussed,collects user data to identify the scale-based biometrics and stores anindication of the scale-based biometrics in a user profile correspondingwith the respective user. During subsequent measurements, the scalerecognizes the particular user by comparing collected signals to theindication of the scale-based biometrics in the user profile. The scale,for example, compares the collected signals to each user profile of thetwo or more users and identifies a match between the collected signalsand the indication of the scale-based biometrics. A match, in variousembodiments, is within a range of values of the indication stored.Further, in response to verifying the scale-based biometric(s), aparticular communication mode is authorized.

In accordance with a number of embodiments, the scale identifies one ormore of the multiple users of the scale that have priority user data.The user data with a priority, as used herein, includes an importance ofthe user and/or the user data. In various embodiments, the importance ofthe user is based on parameter values identified and/or user goals, suchas the user is an athlete and/or is using the scale to assist intraining for an event (e.g., marathon) or is using the scale for otheruser goals (e.g., a weight loss program). Further, the importance of theuser data is based on parameters values and/or user input dataindicating a diagnosis of a condition or disease and/or a risk of theuser having the condition or disease based on the scale-obtained data.For example, the scale-obtained data of a first user indicates that theuser is overweight, recently had an increase in weight, and has a riskof having atrial fibrillation. The first user is identified as a usercorresponding with priority user data. A second user of the scale hasscale-obtained data indicating a decrease in recovery parameters (e.g.,time to return to baseline parameters) and the user inputs an indicationthat they are training for a marathon. The second user is alsoidentified as a user corresponding with priority user data. The scaledisplays indications to user with the priority user data, in someembodiments, on how to use to the scale to communicate the user data toexternal circuitry for further processing, correlation, and/or otherfeatures, such as social network connections. Further, the scale, inresponse to the priority, displays various feedback to the user, such asuser-targeted advertisements and/or suggestions.

In some embodiments, one or more users of the scale have multipledifferent scale-obtained biometrics used to authorize differentcommunication modes. The different scale-obtained biometrics are used toauthorize communication of different levels sensitivity of the userdata, such as the different user data types and sensitivity values asillustrated in the above-table. For example, in some specificembodiments, the different scale-obtained biometrics include a highsecurity biometric, a medium security biometric, and a low securitybiometric. Using the above illustrated table as an example, the threedifferent biometrics are used to authorize communication of theuser-data types of the different sensitivity values. For instance, thehigh security biometric authorizes communication of user-data types withsensitivity values of 8-10, the medium security biometric authorizescommunication of user-data types with sensitivity values of 4-7, and thelow security biometric authorizes communication of user-data types withsensitivity values of 1-3. The user, in some embodiments, can adjust thesetting of the various biometrics and authorization of user-data types.

In a specific example, low security biometrics includes estimated weight(e.g., a weight range), and a toe tap on the FUI. Example mediumsecurity biometrics includes one or more the low security biometric inaddition to length and/or width of the user's foot, and/or a time of dayor location of the scale. For example, as illustrated by FIGS. 2a and 13and discussed with regard to FIG. 3 c, the scale includes impedanceelectrodes that are interleaved and engage the feet of the user. Theinterleaved electrodes assist in providing measurement results that areindicative of the foot length, foot width, foot shape and type of arch.Further, a specific user, in some embodiments, may use the scale at aparticular time of the day and/or authorize communication of data at theparticular time of the day, which is used to verify identity of the userand authorize the communication. The location of scale, in someembodiments, is based on Global Positioning System (GPS) coordinatesand/or a Wi-Fi code. For example, if the scale is moved to a new house,the Wi-Fi code used to communicate data externally from the scalechanges. Example high security biometrics include one or more lowsecurity biometrics and/or medium security biometrics in addition tocardiogram characteristics and, optionally, a time of day, toe print,and/or heart rate. Example cardiogram characteristics include a QRScomplex, and QRS complex and P/T wave, BCG characteristics, ECG-to-BCGtiming, and combinations thereof.

In various embodiments, the user adjusts the table displayed above torevise the sensitivity values of each data type. Further, although theabove-illustrated table includes a single sensitivity value for eachdata type, in various embodiments, one or more of the data types areseparated into sub-data types and each sub-data type has a sensitivityvalue. As an example, the user-specific advertisement is separated into:prescription advertisement, external device advertisements, exerciseadvertisements, and diet plan advertisement. Alternatively and/or inaddition, the sub-data types for user-specific advertisement includegeneric advertisements based on a demographic of the user andadvertisements in response to scale collected data (e.g., advertisementfor a device in response to physiologic parameters), as discussedfurther herein.

For example, weight data includes the user's weight and historicalweight as collected by the scale. In some embodiments, weight dataincludes historical trends of the user's weight and correlates todietary information and/or exercise information, among other user data.Body mass index data, includes the user's body mass index as determinedusing the user's weight collected by the scale and height. In someembodiments, similar to weight, body mass index data includes historytrends of the user's body mass index and correlates to various otheruser data.

User-specific advertisement data includes various prescriptions,exercise plans, dietary plans, and/or other user devices and/or sensorsfor purchase, among other advertisements. The user-specificadvertisements, in various embodiments, are correlated to input userdata and/or scale-obtained data. For example, the advertisements includegeneric advertisements that are relevant to the user based on ademographic of the user. Further, the advertisements includeadvertisements that are responsive to scale collected data (e.g.,physiological parameter includes a symptom or problem and advertisementis correlated to the symptom or problem). A number of specific examplesinclude advertisements for beta blockers to slow heart rate,advertisements for a user wearable device (e.g., Fitbit®) to monitorheart rate, and advertisements for a marathon exercise program (such asin response to an indication the user is training for a marathon), etc.

Physician provided diagnosis/report data includes data provided by aphysician and, in various embodiments, is in responsive to the physicianreviewing the scale-obtained data. For example, the physician provideddiagnosis/report data includes diagnosis of a disorder/condition by aphysician, prescription medication prescribed by a physician, and/orreports of progress by a physician, among other data. In variousembodiments, the physician provided diagnosis/reports are provided tothe scale from external circuitry, which includes and/or accesses amedical profile of the user.

Scaled stored suggestion data includes data that provides suggestions oradvice for symptoms, diagnosis, and/or user goals. For example, thesuggestions include advice for training that is user specific (e.g.,exercise program based on user age, weight, and cardiogram data orexercise program for training for an event or reducing time to completean event, such as a marathon), suggestions for reducing symptomsincluding dietary, exercise, and sleep advice, and/or suggestions to seea physician, among other suggestions. Further, the suggestions or adviceinclude reminders regarding prescriptions. For example, based onphysician provided diagnosis/report data and/or user inputs, the scaleidentifies the user is taking a prescription medication. Theidentification includes the amount and timing of when the user takes themedication, in some embodiments. The scale reminds the user and/or asksfor verification of consumption of the prescription medication using theFUI.

As further specific examples, recent discoveries may align and associatedifferent attributes of scale-based user data collected by the scale todifferent tools, advertisements, and physician provided diagnosis. Forexample, it has recently been discovered that atrial fibrillation ismore directly correlated with obesity. The scale collects various userdata and monitors weight and various components/symptoms of atrialfibrillation. In a specific embodiment, the scale recommends/suggests tothe user to: closely monitor weight, recommends a diet, goals for losingweight, and correlates weight gain and losses for movement in cardiogramdata relative to arrhythmia. The movement in cardiogram data relative toarrhythmia, in specific embodiments, is related to atrial fibrillation.For example, atrial fibrillation is associated with indiscerniblep-waves and beat to beat fluctuations. Thereby, the scale correlatesweight gain/loss with changes in amplitude (e.g., discernibility) of ap-wave of a cardiogram (preceding a QRS complex) and changes in beat tobeat fluctuations.

FIGS. 19a-c show example impedance as measured through different partsof the foot based on the foot position, consistent with various aspectsof the present disclosure. For instance, example impedance measurementconfigurations may be implemented using a dynamic electrodeconfiguration for measurement of foot impedance and related timings.Dynamic electrode configuration may be implemented usingindependently-configurable electrodes to optimize the impedancemeasurement. As shown in FIG. 19 a, interleaved electrodes 1900 areconnected to an impedance processor circuit 1905 to determine footlength, foot position, and/or foot impedance. As is shown in FIG. 19 b,an impedance measurement is determined regardless of foot position 1910based on measurement of the placement of the foot across the electrodes1900. This is based in part in the electrodes 1900 that are engaged(blackened) and in contact with the foot (based on the foot position1910), which is shown in FIG. 19 c.

More specifically regarding FIG. 19 a, configuration includesconnection/de-connection of the individual electrodes 1900 to theimpedance processor circuit 1905, their configuration ascurrent-carrying electrodes (injection or return), sense electrodes(positive or negative), or both. The configuration is preset based onuser information, or updated at each measurement (dynamicreconfiguration) to optimize a given parameter (impedance SNR,measurement location). The system algorithmically determines whichelectrodes under the foot to use in order to obtain the highest SNR inthe pulse impedance signal. Such optimization algorithm may includeiteratively switching configurations and measuring the impedance, andselecting the best suited configuration. Alternatively, the systemfirst, through a sequential impedance measurement between eachindividual electrode 1900 and another electrode in contact with the body(such as an electrode in electrode pair 205 on the other foot),determine which electrodes are in contact with the foot. By determiningthe two most apart electrodes, the foot size is determined. Heellocation can be determined in this manner, as can other characteristicssuch as foot arch type. These parameters are used to determineprogrammatically (in an automated manner by CPU/logic circuitry) whichelectrodes are selected for current injection and return (and sensing ifa Kelvin connection issued) to obtain the best foot IPG.

In various embodiments involving the dynamically reconfigurableelectrode array 1900/1905, an electrode array set is selected to measurethe same portion/segment of the foot, irrespective of the foot locationon the array. FIG. 19b illustrates the case of several foot positions ona static array (a fixed set of electrodes are used for measurement atthe heel and plantar/toe areas, with a fixed gap of an inactiveelectrode or insulating material between them). Depending on theposition of the foot, the active electrodes are contacting the foot atdifferent locations, thereby sensing a different volume/segment of thefoot. If the IPG is used by itself (e.g., for heart measurement), suchdiscrepancies may be non-consequential. However, if timings derived fromthe IPG are referred to other timings (e.g., R-wave from the ECG, orspecific timing in the BCG), such as for the calculation of a PTT orPWV, the small shifts in IPG timings due to the sensing of slightlydifferent volumes in the foot (e.g., if the foot is not always placed atthe same position on the electrodes) can introduce an error in thecalculation of the interval. With respect to FIG. 19 b, the timing ofthe peak of the IPG from the foot placement on the right (sensing thetoe/plantar region) is later than from the foot placement on the left,which senses more of the heel volume (the pulse reaches first the heel,then the plantar region). Factors influencing the magnitude of thesediscrepancies include foot shape (flat or not) and foot length.

Various embodiments address challenges relating to foot placement. FIG.19c shows an example embodiment involving dynamic reconfiguration of theelectrodes to reduce such foot placement-induced variations. As anexample, by sensing the location of the heel first (as described above),it is possible to activate a subset of electrodes under the heel, andanother subset of electrodes separated by a fixed distance (1900). Theother electrodes (e.g., unused electrodes) are left disconnected. Thesensed volume will therefore be the same, producing consistent timings.The electrode configuration leading to the most consistent results maybe informed by the foot impedance, foot length, the type of arch (all ofwhich can be measured by the electrode array as shown above), but alsoby the user ID (foot information can be stored for each user, thenlooked up based on automatic user recognition or manual selection (e.g.,in a look-up-table stored for each user in a memory circuit accessibleby the CPU circuit in the scale).

In certain embodiments, the apparatus measures impedance using aplurality of electrodes contacting one foot and with at least one otherelectrode (typically many) at a location distal from the foot. Theplurality of electrodes (contacting the one foot) is arranged on theplatform and in a pattern configured to inject current signals and sensesignals in response thereto, for the same segment of the foot so thatthe timing of the pulse-based measurements does not vary because theuser placed the one foot at a slightly different position on theplatform or scale. In FIG. 19 a, the foot-to-electrode locations for theheel are different locations than that shown in FIGS. 19b and 19 c. Asthis different foot placement can occur from day to day for the user,the timing and related impedance measurements are for the same(internal) segment of the foot. By having the processor circuit injectcurrent and sense responsive signals to first locate the foot on theelectrodes (e.g., sensing where positions of the foot's heel plantarregions and/or toes), the pattern of foot-to-electrode locations permitsthe foot to move laterally, horizontally and both laterally andhorizontally via the different electrode locations, while collectingimpedance measurements relative to the same segment of the foot.

The BCG/IPG system can be used to determine the PTT of the user, byidentification of the average I-Wave or derivative timing near theI-Wave from a plurality of BCG heartbeat signals obtained simultaneouslywith the Dual-IPG measurements of the present disclosure to determinethe relative PTT along an arterial segment between the ascending aorticarch and distal pulse timing of the user's lower extremity. In certainembodiments, the BCG/IPG system is used to determine the PWV of theuser, by identification of the characteristic length representing thelength of the user's arteries, and by identification of the averageI-Wave or derivative timing near the I-Wave from a plurality of BCGheartbeat signals obtained simultaneously with the Dual-IPG measurementsof the present disclosure to determine the relative PTT along anarterial segment between the ascending aortic arch and distal pulsetiming of the user's lower extremity. The system of the presentdisclosure and alternate embodiments may be suitable for determining thearterial stiffness (or arterial compliance) and/or cardiovascular riskof the user regardless of the position of the user's feet within thebounds of the interleaved electrodes. In certain embodiments, theweighing scale system incorporated the use of strain gage load cells andsix or eight electrodes to measure a plurality of signals including:bodyweight, BCG, body mass index, fat percentage, muscle masspercentage, and body water percentage, heart rate, heart ratevariability, PTT, and PWV measured simultaneously or synchronously whenthe user stands on the scale to provide a comprehensive analysis of thehealth and wellness of the user.

In other certain embodiments, the PTT and PWV are computed using timingsfrom the Leg IPG or Foot IPG for arrival times, and using timings from asensor located on the upper body (as opposed to the scale measuring theBCG) to detect the start of the pulse. Such sensor may include animpedance sensor for impedance cardiography, a hand-to-hand impedancesensor, a photoplethysmogram on the chest, neck, head, arms or hands, oran accelerometer on the chest (seismocardiograph) or head.

Communication of the biometric information is another aspect of thepresent disclosure. The biometric results from the user are stored inthe memory on the scale and displayed to the user via a display on thescale, audible communication from the scale, and/or the data iscommunicated to a peripheral device such as a computer, smart phone,tablet computing device. The communication occurs to the peripheraldevice with a wired connection, or can be sent to the peripheral devicethrough wireless communication protocols such as Bluetooth or WiFi.Computations such as signal analyses described therein may be carriedout locally on the scale, in a smartphone or computer, or in a remoteprocessor (cloud computing).

Other aspects of the present disclosure are directed toward apparatusesor methods that include the use of at least two electrodes that contactsfeet of a user. Further, circuitry is provided to determine a pulsearrival time at the foot based on the recording of two or more impedancesignals from the set of electrodes. Additionally, a second set ofcircuitry is provided to extract a first pulse arrival time from a firstimpedance signal and use the first pulse arrival time as a timingreference to extract and process a second pulse arrival time in a secondimpedance signal. Various embodiments are implemented in accordancewith, and fully incorporating by reference their general teachings, theabove-identified PCT Applications and U.S. Provisional Applications(including PCT Ser. No. PCT/US2016/062484 and PCT Ser. No.PCT/US2016/062505), which teachings are also incorporated by referencespecifically concerning physiological scales and related measurementsand communications such as exemplified by disclosure in connection withFIGS. 1 a, 1 b, 1 e-1 f, and 2 b-e in PCT Ser. No. PCT/US2016/062484 andFIGS. 1 a, 1 c, 1 k, 1 m, 1 n, 1 o, in PCT Ser. No. PCT/US2016/062505,and related disclosure in the above-identified U.S. ProvisionalApplications. For example, above-identified U.S. Provisional Application(Ser. No. 62/258,253), which teachings are also incorporated byreference specifically concerning using a scale to instruct a user tohave a particular posture while obtaining scale-data features andaspects as exemplified by disclosure in connection with FIGS. 1a-1b ofthe underlying provisional; U.S. Provisional Application (Ser. No.62/264,807), which teachings are also incorporated by referencespecifically concerning providing automatically updating patientprofiles using scale-obtained data features and aspects as described inconnection with FIGS. 1a-1d in the underlying provisional; and U.S.Provisional Application (Ser. No. 62/266,523), which teachings are alsoincorporated by reference specifically concerning grouping users intointer and intra scale social groups based on aggregated user data sets,and providing normalized user data to other users in the social groupaspects as exemplified by disclosure in connection with FIGS. 1a-1c ofthe underlying provisional. For instance, embodiments herein and/or inthe PCT and/or provisional applications may be combined in varyingdegrees (including wholly). Reference may also be made to theexperimental teachings and underlying references provided in the PCTand/or provisional application. Embodiments discussed in the provisionalapplicants are not intended, in any way, to be limiting to the overalltechnical disclosure, or to any part of the claimed invention unlessspecifically noted.

Reference may also be made to published patent documents U.S. PatentPublication 2010/0094147 and U.S. Patent Publication 2013/0310700, whichare, together with the references cited therein, herein fullyincorporated by reference for the purposes of sensors and sensingtechnology. The aspects discussed therein may be implemented inconnection with one or more of embodiments and implementations of thepresent disclosure (as well as with those shown in the figures). In viewof the description herein, those skilled in the art will recognize thatmany changes may be made thereto without departing from the spirit andscope of the present disclosure.

As illustrated herein, various circuit-based building blocks and/ormodules may be implemented to carry out one or more of theoperations/activities described herein shown in the block-diagram-typefigures. In such contexts, these building blocks and/or modulesrepresent circuits that carry out these or relatedoperations/activities. For example, in certain embodiments discussedabove (such as the pulse circuitry modularized as shown in FIGS. 3a-b ),one or more blocks/modules are discrete logic circuits or programmablelogic circuits for implementing these operations/activities, as in thecircuit blocks/modules shown. In certain embodiments, the programmablecircuit is one or more computer circuits programmed to execute a set (orsets) of instructions (and/or configuration data). The instructions(and/or configuration data) can be in the form of firmware or softwarestored in and accessible from a memory circuit. As an example, first andsecond modules/blocks include a combination of a CPU hardware-basedcircuit and a set of instructions in the form of firmware, where thefirst module/block includes a first CPU hardware circuit with one set ofinstructions and the second module/block includes a second CPU hardwarecircuit with another set of instructions.

Based upon the above discussion and illustrations, those skilled in theart will readily recognize that various modifications and changes may bemade to the present disclosure without strictly following the exemplaryembodiments and applications illustrated and described herein. Forexample, the input terminals as shown and discussed may be replaced withterminals of different arrangements, and different types and numbers ofinput configurations (e.g., involving different types of input circuitsand related connectivity). Further, the various features andoperations/actions, in accordance with various embodiments, can becombined with various different features and operations/actions and invarious combinations. Such modifications do not depart from the truespirit and scope of the present disclosure, including that set forth inthe following claims.

What is claimed is:
 1. An apparatus including: a scale comprising: aplatform configured and arranged for a user to stand on,data-procurement circuitry, including force sensor circuitry and aplurality of electrodes integrated with the platform, and configured andarranged to engage the user with electrical signals and collect signalsindicative of the user's identity and cardio-physiological measurementswhile the user is standing on the platform, and processing circuitry,including a CPU and a memory circuit with user-corresponding data storedin the memory circuit, configured and arranged with the force sensorcircuitry and the plurality of electrodes to process data obtained bythe data-procurement circuitry while the user is standing on theplatform and therefrom generate cardio-related physiologic datacorresponding to the collected signals; and an output circuit configuredand arranged to receive user data and, in response, send the user data,including data indicative of the user's identity and the generatedcardio-related physiologic data, for reception at external circuitrythat is not integrated within the scale; and external circuitryconfigured and arranged to receive the user data and, in response,validate the cardio-related physiologic data as concerning the userassociated with a patient profile using the data indicative of theuser's identity; and automatically update the patient profile to includea cardiogram measurement and the user's weight using the generatedcardio-related physiologic data.
 2. The apparatus of claim 1, whereinthe external circuitry is configured and arranged to validate thecardio-related physiologic data by comparing at least one physiologicparameter determined using the cardio-related physiologic data to datawithin the patient profile.
 3. The apparatus of claim 1, wherein thedata-procurement circuitry and the output circuit are configured andarranged to capture verification data from the user, wherein the dataindicative of the user's identity including the verification data. 4.The apparatus of claim 3, wherein the verification data includes dataselected from the group consisting of: a password, a physical address, auser ID, a security number, a picture selected on a user display, abarcode, an RFID scan, a communication from another circuitry, and acombination thereof.
 5. The apparatus of claim 1, further comprisinganother circuitry, including a communication circuit, configured andarranged to provide the data indicative of the user's identity to thescale.
 6. The apparatus of claim 1, wherein the processing circuitry isfurther configured and arranged to confirm identification of the userusing the data indicative of the user's identity and the externalcircuitry validates the cardio-related physiologic data as concerningthe user associated with the patient profile by identifying the patientprofile and correlating the cardio-related physiologic data with thepatient profile.
 7. The apparatus of claim 1, wherein: thedata-procurement circuitry and the processing circuitry are configuredand arranged to provide a number of questions to the user includingperforming a question and answer session to identify symptoms and/orreasons the user is visiting a physician, the output circuit isconfigured and arranged to output question and answer data in responseto the question and answer session to the external circuity, and theexternal circuitry is configured and arranged to receive the questionand answer session data and automatically populate the data in thepatient profile.
 8. The apparatus of claim 1, wherein the externalcircuitry is configured and arranged to determine at least one clinicalindication using the cardio-related physiologic data and store theclinical indication in the patient profile for review by a physician. 9.A method comprising: engaging a user, via a scale, with electricalsignals and, therefrom, collecting signals indicative of the user'sidentity and cardio-physiological measurements while the user isstanding on a platform of the scale, wherein the scale includes: a userdisplay configured and arranged to display data to a user while the useris standing on the scale, the platform configured and arranged for auser to stand on, data-procurement circuitry, including force sensorcircuitry and a plurality of electrodes integrated with the platform,processing circuitry, including a CPU and a memory circuit withuser-corresponding data stored in the memory circuit, configured andarranged within the scale and under the platform upon which the userstands, the processing circuit being electrically integrated with theforce sensor circuitry and the plurality of electrodes, and an outputcircuit; processing, using the processing circuitry, data obtained bythe data-procurement circuitry while the user is standing on theplatform and therefrom generating cardio-related physiologic datacorresponding to the collected signals; displaying the user's weight,determined using the scale, on the user display; outputting, using theoutput circuit, user-data, including data indicative of the user'sidentity and the generated cardio-related physiologic data, from thescale for reception by external circuitry that is not integrated withinthe scale; validating the cardio-related physiologic data as concerningthe user associated with a patient profile using the data indicative ofthe user's identity; and automatically updating, using the externalcircuitry, the patient profile to include a cardiogram measurement andthe user's weight using the generated cardio-related physiologic data.10. The method of claim 9, further including performing, by the scale, aquestion and answer session to identify symptoms and/or reasons thepatient is visiting a physician and updating, by the scale and theexternal circuitry, the patient profile to include answers from thequestion and answer session.
 11. The method of claim 9, furtherincluding estimating a height or other relevant distance of the user byone of: measuring using a physical arm that is connected to the scale;receiving an input measurement to the scale as measured by the userand/or another user; receiving a user input estimate of the measurementto the scale; using look up tables and at least one of: a sensor on theuser's finger; and a head sensor on the user's head.
 12. The method ofclaim 9, further including determining a relevant distance by:instructing, by the scale, the user to their place hand at their waistusing instructions from the scale, written instructions on the userdisplay, and/or a picture on the user display of the scale; outputting alight source from the scale toward a location of the user's hand; anddetermining the relevant distance based on a return from the lightsource reflecting back from the user's hand.
 13. The method of claim 9,wherein the external circuitry further includes an output circuit, andthe output circuit is configured and arranged to output a signal tocircuitry accessible by a physician responsive to the update of the userprofile, the signal being indicative of completion of a check-inprocess.
 14. The method of claim 9, wherein the external circuitryfurther includes an output circuit, and the output circuit is configuredand arranged to output a signal to circuitry accessible by a physicianor another personal in response the user data and/or data determinedusing the user data being outside a threshold value.